Key points
- A growing number of GPs are charging disadvantaged people instead of bulk billing them because the Medicare rebate isn’t covering their costs.
- Medicare patient rebates for GP consultations were frozen from 2013 to 2019, and received a small boost earlier this year, of 1.6 per cent.
- Just over 80 per cent of national medical services were bulk billed in the 2021-2022 financial year.
An increasing number of GPs across Australia are opting to charge disadvantaged people a fee instead of bulk billing them because the Medicare rebate doctors receive to see patients isn’t covering rising costs.
“Up until recently, those practices that didn’t bulk bill everyone, they would as a routine policy bulk bill pensioners and health care card holders,” said Leanne Wells, chief executive of the Consumers Health Forum. “But now some are starting to say ‘Look, we can’t even afford that guarantee any more’.”
Kathy Barr and her family love their local GP clinic, which has bulk billed them for the last five years. It recently started charging to see them.Credit:Nick Moir
Bulk billing is where medical practitioners charge the federal government for providing a service to patients, instead of the patient paying up front.
Health Minister Mark Butler on Friday said primary care was “in its worst shape since Medicare began” in 1984, and that stories were now common of Australians not being able to see a bulk billing doctor, or of GPs changing from bulk billing to charging a small fee, as well as getting the rebate.
“The former government froze the Medicare rebate for six years, ripping billions of dollars out of primary care and causing gap fees to skyrocket,” Butler said.
Figures released by the government this week showed that 82.2 per cent of national medical services were bulk billed in the 2021-2022 financial year.
While GPs are not obliged to bulk bill health care card holders and patients from low socio-economic groups, or those who have a pension card, they generally have since Medicare’s inception in 1984.
“Medicare was introduced as a universal health system, with high bulk billing rates for many years,” Wells said.
“We now have a system where universalism is at risk, and patients paying more in out-of-pocket costs for a basic GP visit than the rebate. This is just going to lead to more people not getting the care they need.”
The Royal Australian College of General Practitioners warned this week that inadequate Medicare rebates were leading an increasing number of GPs who had previously bulk billed all consultations, to start charging patients.
Melbourne GP Anita Munoz, who chairs the Royal Australian College of General Practitioners’ Victorian faculty, said the rebate given to doctors had not increased in real terms for many years, and that many GPs could not afford to continue bulk billing without charging a gap fee.
“The cost of delivering care has so far outstripped the contribution from Medicare that not charging a gap is no longer feasible,” she said.
Medicare patient rebates for GP consultations were frozen from 2013 to 2019, and received a small boost earlier this year, of 1.6 per cent. Munoz said no other industry could continue under such circumstances. “And our industry is now showing that it will collapse under that weight unless something changes.”
GPs want Canberra to raise the Medicare rebate by 10 per cent for doctor visits between 20 and 40 minutes, and to also introduce a new rebate for one-hour consultations for patients requiring complex care. The call is included in an advocacy plan put out by the RACGP this week.
Education service HealthEd recently released a poll of almost 500 GPs that found 22 per cent had recently changed their billing model, meaning patients faced higher out-of-pocket costs to see a GP. A third of those that changed their billing model moved from bulk billing to mixed billing (a combination of bulk billing and private billing), while 67 per cent changed from mixed billing to completely private billing.
Kathy Barr has two daughters, aged 24 and 19, and for the past five years the family has visited a local clinic. “They bulk billed, and we initially went to them when money was tight because we also found a really good doctor in the practice,” says Barr, 60, who lives in Stanmore, in Sydney’s inner west.
In April, the practice stopped bulk billing. Barr caught pneumonia in 2019, and then in late 2021 had treatment for a benign brain tumour, which still requires monitoring, and has required constant access to specialists – most of whom require her to see a GP for a referral.
“Because I have to get multiple prescriptions, it’s often a double appointment, which is $160,” she said. About $80 of that is refunded via Medicare. Barr said she could cover it. “I’ve got a professional career, but that’s still a lot of money. So I hesitate to see a doctor when I should, due to the cost.”
And Ms Barr said the charges had all but stopped her daughters going unless it was absolutely vital.
“Once bulk billing finished, it made it almost impossible. When you have a complex medical condition, on top of what happened during the pandemic, and then not having access to bulk billing – it means really serious impacts on the individual.”
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