‘We can’t keep going this way’: GPs’ petition to save bulk billing

Jolyon Attwooll

20/03/2023 5:02:25 PM

Higher rebates and funding for longer consultations are among the all-too-familiar requests, with a GP Principal saying more clinics will close if there is no change.

Dr Sudeer Mahadeo
Dr Sudeer Mahadeo is hoping his message about general practice will be heard at the highest level of government.

Everyone has a tipping point – and for Dr Sudeer Mahadeo, who works as the GP Principal at Goodna Family Medical Centre in southern Queensland, the silence from federal representatives about the financial pressures facing general practice has proven too much.
‘I have sent them emails, and I haven’t had any response from them – so I thought I’d start the petition,’ Dr Mahadeo told newsGP.
His plea through online petition platform, which has gathered just over 450 signatures at the time of writing, calls for higher rebates and funding for longer consultations, among other measures.
Dr Mahadeo is now seeking to amplify a message he wants to send to Federal Minister for Health and Aged Care Mark Butler, as well as Prime Minister Anthony Albanese.
‘Our practice here has been a bulk billing practice for the past 16 years and it is only now that we have changed to mixed billing,’ he said.
‘We have found that in past years, we’ve managed to absorb the freezes that they put in and just persist.
‘However, after COVID hit and inflation had gone up 6–7% each year, it’s made it extremely financially difficult for GPs, and that’s what tipped everything.
‘The amount that we get to manage and run a practice is clearly insufficient.’
The Goodna clinic is one of five operated by the Your Family Medical Centre, with Dr Mahadeo saying the group recently needed to shut down a practice in nearby Ipswich as it became unsustainable.
The RACGP has called for increased rebates as central to any Medicare reform, with most GPs ranking that as the action that would make the single biggest difference to general practice.
Since mixed billing was introduced at the Goodna clinic to attempt to retain doctors, Dr Mahadeo has noticed a significant impact on patients.
‘A lot of our patients are having difficulty even paying the out-of-pocket fee,’ he said.
‘As you are aware, Medicare requires patients to pay an upfront fee, and then get a rebate. A lot of our patients don’t have that amount of money to pay the upfront fee. For example, take a patient with two or three kids coming in for the same type of illness to the doctor. They have to have a couple of hundred dollars up front.
‘Yes, they get the Medicare rebate back, but they have to have that money up front before they can get the rebate.’
As a result, the petition is also calling for patients to be able to pay only gap fees, without having to pay everything up front.
‘They don’t seem to understand that not everybody has credit cards and not everyone has enough to pay up front immediately,’ the petition states.
Dr Mahadeo also describes the local emergency department as ‘creaking at the seams’, a situation he believes is exacerbated by patients attending with minor issues due to affordability concerns.
‘Twenty dollars out-of-pocket is what we charge, which is not very much if you look at it, but a lot of people are doing it tough at the moment,’ he said.
But even with the new model of mixed billing, Dr Mahadeo says the change has had a limited impact due to the area’s demographics – and believes time could be limited for the Goodna clinic without change.
‘If it persists, then I don’t think our clinic will be able to remain open in this area past another 12 months,’ he said.
It is smaller clinics, with two or three doctors, that Dr Mahadeo believes will feel the pressure most acutely.
‘Bigger clinics may be able to weather the storm for a while … but we can’t keep going this way,’ he said.
‘The Government needs to come to the party and increase the rebates. There is no job in the world where you can say “Okay, we will not give you an increase for 10 years, and that will remain sustainable”.
‘That’s exactly what they’ve done; they haven’t given GPs an increase for 10 years.’
While the Goodna clinic has moved to mixed billing, Dr Mahadeo is clear that he would rather bulk bill in an area where many of the patients come from lower socio-economic backgrounds.
‘We have one of the best health systems in the world because patients can get access to doctors whenever they need to and they don’t need to be concerned about money involved,’ he said.
‘The other thing is, as a GP, when you’re dealing [with] patients, the last thing you want to be concerned about is the finances.
‘There’s a conflict of interest there when you bring money into the equation.
‘If you start making it mixed billing, GPs eventually will start doing well, because we can charge whatever we want to.
‘The problem would be the people who cannot afford to pay for that and end up in the emergency departments. And, ultimately, we end up with a two-tier healthcare system.
‘Basically what will happen is the same thing that’s happening in the United States – if you have got money, you will get healthcare. If you don’t, you won’t.
‘My ethos has always been to make sure that I get job satisfaction from the people that I treat, and I can treat them just as well as anybody in some higher socio-economic areas would get treated.’
‘I believe in a social democracy, and I believe that, like food, shelter and clothing, you need health care the same way. It’s all essential.
‘Most of the doctors who work with me and in our practices have the same kind of ethos.’
In recent months, the decrease in bulk billing rates has become clearer with the most recent government statistics showing overall levels have reached their lowest in more than a decade.
Patients are also raising the decline in bulk billing rates as an increasingly important concern.
Minister Butler has not committed to rebate rises, but has said they are ‘not off the table’.
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Dr Rasanga Seneviratne   21/03/2023 8:19:20 AM

I find it hard to believe that people who have no HCC or Pension are unable to pay the gap fee. I work in a mixed billing practice for years and recently we started charging even people on HCC and Pention a gap fee for surgery and other procedures. Most have no issues paying a gap fee and are sympathetic that we have to resort to charging them and blame the government. Some of them mention to me that they are even happy to pay a gap fee for consults.
Continuing billing a gap fee and reducing the bulk-billing rate is the only way we can pressure the government and we should stop begging for more rebates. We should have measures to help the most vulnerable but at the end of the day, GP practice is a business and we need to make this viable and attractive to new graduates. Once the bulk-billing rate continues to drop they will most likely increase rebates.

Dr Peter James Morero   21/03/2023 11:01:37 AM

About all one can say about Medicare and private health insurance in Australia is that its better than the US system. We really need structural reform and innovative ways to fund things, such as medical savings accounts used in Singapore and integrated systems such as the Danish model. As usual politics gets in the way.

Dr Ian   21/03/2023 12:15:06 PM

The Governments Liberal and Labour have exploited the caring and devoted nature of doctors by Medicare rebate freezes or half CPI increases after years of freezes.
There is evidence of over claiming but the majority of General Practitioners are wholesome and honest.
This is a Labour Government and it has a policy of protecting and supporting the most vulnerable so a just Medicare rebate rise is expected.
Although it has not been universally accepted as useful Care Plans and Aged Care Reviews when performed thoroughly are beneficial to patients though always there is in medicine the capacity to improve on many aspects of care .
Australia still has one of the highest life expectancies in the world though there is disappointing less life expectancy for Indigenous and other vulnerable people such as the mentally ill. So in general health care including Primary Care is of high standard though not yet at the hoped-for optimal zone.

Dr Christine Colson   22/03/2023 10:57:06 AM

'I believe in a social democracy, and I believe that, like food, shelter and clothing, you need health care the same way. It’s all essential.' I don't understand this logic. Food, shelter and clothing aren't 'bulk billed'. Healthcare is a service. It may be different from other services in that patients on Centrelink cards generally are bulk billed but why should this apply to patients who do not qualify for Centrelink cards? Until all GPs speak with one voice on this issue, governments have a leave pass to do nothing. The so-called 'ethos' your doctors share I also find confusing. Where does this come from? ‘There’s a conflict of interest there when you bring money into the equation'. I can't understand this statement either. Are we saying that GP services, as distinct from non-GP specialist services, are a registered charity? I could understand all the statements I have referred to if that was the case.