‘We need better measures beyond just bulk-billing rates’

A focus on bulk-billing rates risks obscuring the real impact of general practice, the RACGP President Dr Michael Wright has argued in an opinion piece published this week.
 
He co-authored the article, ‘Is the term bulk billing still relevant in today's landscape of health policy reform?’, in the latest issue of The Medical Journal of Australia (MJA).
 
Dr Wright, the previous chair of the RACGP Expert Committee – Funding and Health System Reform, queries the value of reporting bulk-billing rates alone as a way of judging general practice success.
 
‘I wrote this prior to my election as RACGP President to prompt some discussion around the use of bulk billing as a metric,’ Dr Wright told newsGP.
 
‘We need better measures beyond just bulk billing to understand the quality and value of general practice services.’
 
Dr Wright stressed that the impact of triple bulk-billing incentives, a move advocated for by the RACGP and introduced a little over a year ago, was a significant one.
 
‘We’ve seen that additional incentives to bulk bill concession card holders and children under 16 have been highly effective in increasing the rates of consultations with no cost to the patient,’ he said.
 
‘That’s something we very much welcome.’
 
Since tripled bulk-billing incentives came into force in November last year, GPs bulk billed an additional 5.4 million consults, according to Federal Government data released earlier this month.
 
It revealed that 77.3% of GP visits were bulk billed in October this year, with increases in every state and territory.
 
However, Dr Wright’s MJA article also outlines the impact of a decline in the relative value of the Medicare rebate since it was introduced.
 
It highlights how from 1995 to 2022, increases to the Medicare rebates averaged at slightly more than 1.1% each year, while inflation reached up to 7.3% during the same time.
 
'Many general practice services continue to be provided without cost to patients despite the increasing complexity of healthcare,’ the article states.
 
‘This complexity requires a funding model that better supports the longer time spent with patients, something the current Medicare rebate structure devalues.’
 
When Medicare first started, bulk-billing payments covered 85% of the cost of providing care, with that rising to 100% in 2004.
 
‘The current Medicare rebates haven’t kept pace with increasing costs of running a practice and don’t come close to covering the full cost,’ Dr Wright said.
 
‘By focusing on the bulk-billing rate, we can overlook the true costs of care and overlook the value, quality and range of work that we’re doing in our practices.’
 
Inconsistencies in the definition of bulk billing are another theme of the MJA opinion piece.
 
‘The term bulk-billing practice has been variously applied to practices that offer some bulk billing, some practices that bulk bill the majority of their patients, as well as those that exclusively bulk bill,’ Dr Wright said.
 
He argues that these different interpretations have led to an inconsistent understanding.
 
‘And importantly, most general practitioners agree that there is neither a standardised nor an accepted definition of this metric,’ he wrote.
 
Limited public understanding of the way bulk billing works is also an issue, according to Dr Wright, who says he has fielded inquiries about the term while working as a GP.
 
‘Over the years many people, patients, researchers and policymakers, have asked me what “bulk billing” really means,’ he said. 
 
‘My dad was a GP and I remember in his practice he would have a bundle of paper receipts which he sent in bulk to Medicare. He would then wait for these “bulk-billed” receipts to be paid.   
 
‘This paper-based process hasn't been used for many years but the term still exists.’
 
For Dr Wright, the need for adequate funding across all GP services – and not just those that are bulk billed – should remain at the heart of the discussion, with general practice financial viability being vital.
 
‘We look forward to more measures which increase affordable access to general practice care to all Australians,’ he said.
 
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