Bulk billings decline as primary care patient deductibles exceed Medicare rebates

“Primary care is in its worst state since Medicare began… Across the country we hear stories of Australians not being able to see a mass-billed doctor, or GPs switching from mass-bill to mixed-bill,” he said.

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Public health researcher Dr. Christopher Harrison of the University of Sydney said there is skepticism about official Medicare numbers, which calculate the overall rate of services being billed in bulk rather than the proportion of patients who can access them.

“I find these numbers surprisingly high considering that in many areas today it’s almost impossible to find a practice that does bulk billing,” he said. “Nevertheless, after years of increases, we had our first drop in 2021-22 [in the data].”

Alternative data from online healthcare directory Cleanbill, which surveyed 4,188 Australian GP clinics over the last six months of last year, points to a sharper decline. The survey found that only 42.7 percent of GP clinics offered bulk billing to all patients, while the average gap fee for the clinics that didn’t provide bulk billing was $40.25 for a 15-minute consultation.

Health economist Stephen Duckett said only about two-thirds of the population bulk bills for all their GP visits.

“Secondly, it is very unevenly distributed. Affluent suburbs have a much lower proportion of attendances billed in bulk, but notably in some parts of rural and regional Australia there are also low rates,” he said.

“This information is not easy to come by and there is not enough transparency as there should be.”

Butler said he asked his department for more complete and accurate data on the state of bulk billing in Australia.

“The previous government was not honest with Australians about the true state of bulk accounting in Australia by selectively citing figures,” he said.

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Harrison said the increase in physician fees is understandable given that Medicare rebate increases have traditionally been below inflation or frozen for years.

“My concern isn’t with the size of the co-payments, but with the fact that they’re happening at all,” he said.

“If we want a world-class healthcare system, then we don’t want a financial barrier to general medicine, which is one of the most cost-effective forms of healthcare in our system, certainly more so than emergency room visits.”

The Australasian College for Emergency Medicine released an informal poll of its members this week, backing the Prime Ministers’ concerns. It found that emergency department directors anticipate widespread shortages over the next year due to unsustainable working conditions, including a 28 percent shortage of residency trainees, 30 percent of junior physicians and 10 percent of senior decision makers.

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Andrews and Perrottet are calling for changes to Medicare rebates to improve pay for GPs and take pressure off state hospitals. The Australian Medical Association and the Royal Australian College of General Practitioners support similar guidelines but have said billions in additional funding would likely be needed.

A federal task force on Medicare reform will finalize its report this month, and Labor has pledged to use the $750 million Medicare fund to implement its recommendations.

However, some taskforce members, including Duckett, have said that the focus of additional funding should be a more comprehensive system overhaul, as there is no guarantee that increasing Medicare rebates will result in more bulk billing or greater availability of family doctor services.

https://www.smh.com.au/politics/federal/gp-patients-out-of-pocket-costs-outstrip-medicare-rebate-as-bulk-billing-falls-to-near-decade-low-20230111-p5cbtk.html?ref=rss&utm_medium=rss&utm_source=rss_politics_federal Bulk billings decline as primary care patient deductibles exceed Medicare rebates

Callan Tansill

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