Labor has announced a huge boost to Medicare funding aimed at increasing the rate of bulk billing by GPs. In 2023 the government tripled the bulk-billing incentive for doctors who bulk billed pensioners, concession card holders and children. Labor has now said it will expand that incentive to all Medicare cardholders from November and that the incentive will be increased in regional and remote areas.
The government will pay an additional 12.5% loading on Medicare rebates to practices that bulk bill all their patients.
The opposition has promised to match the spending commitment, which also includes funding for nursing scholarships and GP training.
Despite the bipartisanship it looks likely that Medicare and bulk billing will figure prominently in the election campaign, so it’s worth taking a look at all the statistics, from official government numbers to patient surveys.
GP bulk-billing rates
First, a quick reminder of how bulk billing works.
Visits to the doctor are subsidised by the government via Medicare, and the amount that doctors receive is indexed – that is, the dollar value is increased by a certain amount each financial year. In 2013 Labor introduced a “temporary” freeze on indexation, which the subsequent Coalition government kept in place.
This meant that the money doctors (and other health professionals) received from the government stayed the same as costs rose. Indexation was returned gradually from 2017 but groups representing health professionals have long said the amount they receive from the government is inadequate and, consequently, the average out-of-pocket cost for patients visiting the GP has risen.
The rate of GP visits that are bulk billed has decreased but that change is more recent.
The statistic the government usually uses to track bulk-billing rates is the percentage of non-referred GP visits that were bulk billed in a given period of time.
This metric shows that bulk-billing rates are lower than they were before the pandemic.
The rate peaked during Covid, when compulsorily bulk-billed services related to vaccines were introduced, then it declined until the 2023 bulk-billing incentives.
The cost-of-living crisis
From 2021 Australia and other countries faced a sharp increase in inflation, in part due to Covid-related supply-chain disruptions, the war in Ukraine and severe weather events. Combined with longstanding housing cost pressures, this increased financial stress for many Australians.
Since 2021 the trend of GP visits increasing over time has been broken.
Survey data from the Australian Bureau of Statistics suggests this is partly because of the increasing cost of GP services.
The patient experience survey shows the percentage of people who said they avoided going to the GP at least once in a year due to the cost is now at the highest level in the 11-year period the survey covers.
More people are waiting longer to see a GP, too. The rate of people who said they waited longer than they felt acceptable to get an appointment with a GP is high in historical terms, though down slightly year-on-year. This may indicate that people who are still being bulk billed have to wait longer due to competition for appointments, as the number of GP clinics that bulk bill all patients has declined.
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How does bulk billing vary across the country?
Bulk-billing rates are not uniform across Australia, with the Australian Capital Territory having by far the lowest rate, followed by Western Australia and Tasmania.
Not surprisingly, the electorates with the lowest rate of GP bulk billing are all in the ACT. The electorates of Canberra, Bean and Fenner ranged from 48.6% to 55.5% in 2023-24, according to health department data provided to the Senate. The Tasmanian electorates of Franklin and Clark also had low rates, as did Curtin in WA, and Warringah and Newcastle in New South Wales.
We can also look at the availability of dedicated bulk-billing GP clinics in each electorate, using the government’s Healthdirect database.
This database lists thousands of GP clinics along with their self-described billing practices, and includes a category for clinics that bulk bill everyone, not just concession card holders or young people. From this information we have calculated the percentage of dedicated bulk billing providers in each electorate, which you can see in the map above.
At least six electorates – Fairfax (Queensland), Jagajaga (Victoria), Mayo (South Australia), Shortland (NSW), Franklin (Tasmania) and Fenner (ACT) – had no bulk billing-only clinics listed in Healthdirect.
Analysis of this data in February showed that many dedicated bulk-billing GP clinics were switching to a mixed billing approach.
Separately, the medical billing company Cleanbill has surveyed all the GP clinics it can find in Australia, and its report has shown similar results.
What do health experts and doctors say?
The government says nearly 5,000 GP clinics will be better off if they adopt comprehensive bulk billing under the new scheme, and forecasts the new incentives will mean an additional 18m bulk-billed GP visits every year.
By 2030, the government claims, nine out of 10 GP visits will be bulk billed, saving Australians up to $859m each year in out-of-pocket health costs.
Doctors and health policy experts say the changes are a much-needed boost to funding, and will improve healthcare access in rural and regional areas, but they think more changes are needed.
The Royal Australian College of General Practitioners has advocated increasing the rebate for longer consultations to prioritise the care of people with chronic health conditions.
The health policy experts Peter Breadon and Elizabeth Baldwin from the Grattan Institute argue that broader changes are needed to the funding model for primary care and suggest funding should be more flexible to provide better support for people with chronic conditions.