Key Points
- GPs will soon receive triple the current pay incentive to bulk bill concession card holders and children under 16.
- Some GPs worry the scheme won't help with the costs of running a clinic, and could disadvantage some patients.
- Most doctors incur a loss when they bulk bill, and many are finding their clinics are no longer financially viable.
The Australian government will triple the incentive paid to doctors who bulk bill certain patients from 1 November, in a bid to improve access to primary health care for vulnerable demographics.
Doctors who bulk bill children under 16 years of age and Commonwealth concession card holders, including seniors, are currently rewarded for doing so with an additional 'incentive' payment of $6.85 in metropolitan areas and as much as $13.15 in very remote areas.
As of Wednesday, that payment will triple, with GPs receiving an incentive of between $20.65 and $39.65 depending on location.
Bulk billing is when the patient doesn't have to pay for the coat of medical care as the 'bill' is covered by Medicare. Source: AAP / Dave Hunt
Bulk billing means the patient doesn't have to pay for medical care as the practice bills Service Australia, who pays a Medicare benefit back.
Often though there is still a 'gap' fee charged to the patient when the practitioner wants you to pay the additional cost of the appointment not covered by Medicare.
Rates of doctors who bulk bill have declined in recent years, as the rising cost of providing health care outpaces the Medicare rebate and GPs feel less inclined to cover the difference.
The change, announced as part of the in March, has been broadly welcomed by groups like the Consumers Health Forum of Australia and the Australian Medical Association (AMA), whose president Steve Robson said at the time: "All in all, we are very happy."
But some economists and healthcare professionals have raised concerns that the new scheme doesn’t go far enough to address the needs of some of Australia's most vulnerable patients – and may in fact fuel further inequity.
"I don't think it's going to change the number of people who get bulk billed, and I don't think it's going to change the inequity," Louise Stone, associate professor at the ANU School of Medicine and Psychology and a practising GP, told SBS News.
"We're still going to have doctors who can't make it work because everything's just got so much more expensive, and the cost of the consultations just keeps going up."
Nathan Kettlewell, an economist and senior lecturer at UTS Business School, said that while the change to the bulk billing incentive marked a significant investment from the federal government – $3.5 billion over five years – it isn't "addressing the fundamental issues with bulk billing".
"Increasing compensation for GPs doesn't really do anything to change the cost of operation," he told SBS News. "So those cost pressures are still going to continue to emerge."
Another concern shared by both Stone and Kettlewell is that by targeting specific demographics the new system gives GPs less financial incentive to see patients who fall outside that criteria.
"Think about this from a perspective of a clinic: a patient who's 64 years old is very similar to a patient who's 65 years old, but now the financial benefit of treating that 65-year-old is just way higher as a result of this," said Kettlewell.
"I can't see GPs turning away particular groups or anything like that. But obviously specialising in the care of groups that are more financially remunerative – that would be a concern."
Although the incentive is geared in favour of age demographics that are most likely to see a GP – namely older people – Kettlewell points out that it doesn't cover people from other demographics who may be similarly if not more vulnerable, whether for reasons of health or money.
"The groups who don't qualify for these payments potentially do get charged higher prices, and that includes very vulnerable groups," he said. "When you're targeting based on age – [and] they're pretty much just targeting on age here – you're ignoring single parents who are on very low incomes, or people who are low socioeconomic status but of a working age, and so forth."
Stone raised concerns that the kickback for GPs who bulk bill may incentivise some to perform shorter consultations to get more people through the door and lift their hourly wage.
In this way, she said, it is the corporate clinics with high patient turnover, many of which can already afford to bulk bill, that stand to benefit from this system.
"The corporates are already doing six-minute medicine, so they're going to be the ones that go from $350 an hour take-home to $500 an hour take-home if they bulk bill because they're doing short consultations," she said.
Similarly, she added, people with complex conditions who require more in-depth consultations may be disadvantaged.
"People dropping in who want something relatively simple or straightforward, they're going to have a benefit. But the ones who've got five chronic diseases and don't speak English, Aboriginal patients, patients with intellectual disability, anyone who's complicated enough to not do things in six minutes, is going to be worse off."
"The bit that's missing is complexity and diversity."
Sky-high costs of running medical practices
Multiple GPs and RACGP members commented on the organisation's website, that the changes weren't an equitable solution, and would do little to meaningfully address the increasingly insurmountable costs of running a medical practice.
A 2022 survey of doctors found that 48 per cent of respondents said their practices were no longer financially sustainable, amid growing operating costs for insurance, rent, wages and clinical equipment – all of which have to be covered by the GP.
The AMA acknowledges "in most cases, the incentive and your rebate do not cover your doctor’s true cost of providing healthcare. In fact, most doctors incur a loss when they bulk bill".
Robson said the "chronic underfunding of Medicare" has meant that the system has failed to keep up with the rising cost of health care, and that Australian patients have ultimately suffered as a result.
"These measures included by the federal government in the 2023 budget are so important," said Robson, "but it’s still a work in progress," he wrote in an article published on the AMA website in September.
SBS News contacted AMA for comment, but did not receive an official response.
