If John Hopkins had needed to pay to see his doctor for help with serious mental health issues two decades ago, he says he’d likely be dead.
“I was going down a dark path. I don’t know where I’d be – probably six foot under,” the former nurse says from his Moonee Ponds home. “It would have been very hard if I’d had to pay. A lot of people can’t afford to see a GP, so they either don’t go or they go to emergency.”
John Hopkins, 60, had major surgery recently and would have struggled financially if not for bulk billing.Credit:Chris Hopkins
Supporters of continued access to free medicine say Hopkins is a prime example of why the federal government must increase the rebate paid to GPs so that bulk billing – where practitioners receive a Medicare rebate for providing services to patients instead of patients paying up front – remains widely available.
Rebates were frozen by Labor in 2013 and kept unchanged by the Coalition until a 1.6 per cent increase this year.
“Medicare rebates have been frozen for so long it’s forced many GPs to introduce a co-payment just to survive,” says former Greens senator and ex-GP Richard Di Natale, who now works as a public health adviser to Cohealth, which runs community health centres across Melbourne.
Former prime minister Tony Abbott tried to introduce a mandatory co-payment to see a GP in 2013.
“There was a huge backlash, so they backed down,” Di Natale says. “But instead of just doing it with one big blow, we’ve now got a co-payment by stealth.”
Cohealth supports increasing the Medicare rebate for GPs, but the provider also wants an additional payment for doctors treating “complex” clients, such as rough sleepers, refugees, and those with multiple social and health challenges.
The Royal Australian College of GPs has led the argument that access to bulk billing is falling across Australia and is now well short of both the 88 per cent claimed by the previous government and the 82 per cent figure released by the health department last week.
On Thursday, Health Minister Mark Butler said the former government’s 88 per cent figure was reached by “selectively quoting” bulk billing. Butler said he had asked his department for more information “to obtain a more complete and accurate picture”.
Stephen Duckett, a health economist and University of Melbourne honorary professor, is concerned too much is being made of the decline in bulk billing, which he says has fallen around 1 to 2 per cent in the last six months.
“Whether it continues that decline, we don’t know yet,” says Duckett, a former federal Health Department secretary who is now part of the Albanese government’s Medicare taskforce, which will report by the end of the year.
Duckett says there could be a case for additional funding for GPs, who the Australian Bureau of Statistics found in 2021 had an average weekly salary before tax of $3300, or about $172,000 a year.
But he also says that increasing rebates for GPs is not the only way money can be found to help maintain Medicare. “You might decide to give other payments; to nurses to reduce their waiting times, things like that. It’s quite a complex issue.”
The Royal Australian College of General Practitioners says just 64 per cent of trips to the GP were bulk billed, according to its 2021 Health of the Nation report into general practice billing methods. For those GPs who charge a fee on top of the Medicare rebate, the average out-of-pocket cost for patients was about $39. The report also found that a third of doctors planned to increase those fees in 2022.
A survey by the college of its GP members last week found a quarter of those who did not currently charge their patients plan to introduce a co-payment in the future.
College president Karen Price says unless greater investment in general practice is made, “more and more practices will have little choice but to pass the cost on to patients or close their doors”.
For Hopkins, had those costs been passed on when he started seeing his GP, Dr Paul MacCartney, at a Fitzroy community health centre, the “dark path” he was on could have led to a far darker place.
“I guess he saved my life. He reassured me over and over again that things would be okay eventually,” Hopkins says.
For the past five years, psychological conditions, including sleep disturbance and depression, have been the most commonly reported reasons for GP visits. And mental health visits are increasing.
Hopkins spent years visiting MacCartney and today considers himself on top of the issues that dogged him for years. “I still suffer, but I’ve learned to manage,” he says .
The 60-year-old says when he started seeing MacCartney, there was no way he could have afforded even a $10 or $20 “gap fee” to see a GP.
Born in East Gippsland, Hopkins worked as a nurse in hospitals, psychiatric homes and aged care. He quit nursing about a decade ago as he struggled with depression and anxiety. Today, he says his part-time “lollipop man” job – a primary school crossing supervisor – is far more relaxed.
Hopkins says if he had been forced to shop around for a doctor that bulk billed, he simply would have stopped going.
“You strike up a relationship with your GP. Paul and I have a great relationship. I can tell him anything.”
Crisis support is available from Lifeline on 13 11 14.
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