It was once a cornerstone of Australia's health system, but the latest data shows bulk-billing is disappearing.
Research by online healthcare directory Cleanbill shows only 35 per cent of clinics nationally still offer bulk-billing and in four federal electorates — Newcastle (NSW), Mayo (SA), Fairfax (Qld) and Franklin (Tas) — no local GPs offer the concession.
That leaves many people facing about $40 in out-of-pocket costs to see a doctor or face lengthy waits in emergency departments.
Jasmine Davies, 32, recently moved to Tamworth from Newcastle after struggling to find support.
"I suffer from mental health issues and I could not afford to deal with those issues as there was no bulk-billing GP in the Newcastle area," she said.
"I had a regular GP that I was seeing … but it just got to the point where I couldn't afford to see him anymore," she said.
"I ended up going to the emergency room at Waratah and was treated there."
Ms Davies said both her mental health and living situation "deteriorated" as she was unable seek assistance with medication and treatment.
"I was homeless for a period of time also," she said.
"So then, about six weeks ago I moved to Tamworth … where I could access a bulk-billing GP."
'Incredibly difficult' to sustain financially
On the NSW Mid North Coast, only one bulk-billing clinic remains in the electorate of Cowper, which includes the large centre of Coffs Harbour.
West of the city, Bellingen GP and practice owner Kelly Hamill bulk-bills 95 per cent of her patients.
Dr Hamill said it was "incredibly difficult to financially sustain bulk-billing" and that it cut into her income.
"When I started in 2012 the [Medicare] rebate for a standard consultation was $34.90 and now it's $39.75," said Dr Hamill.
"Bulk-billing rebates for GPs are just not keeping up with the cost of running a practice."
She said the mortgage on her building had grown from $700 a week at the time of purchase, to $1,000 a week.
"All of our little bits and pieces cost money … $2 for a little ear bud to look in your ear to see if you have wax, $7 for a speculum, all this stuff costs a lot of money."
In the neighbouring electorate of Page, single mother Grace, who did not want to use her surname, has been unable to find a bulk-billing GP near where she lives in Halfway Creek.
Grace has diabetes and requires regular visits to a doctor, which she says are becoming unviable on a single parent pension.
"I'm only going to a doctor for a two-minute appointment and it's only to get scripts, referrals and blood tests done, which I need to have done every three months," she said.
"So, to get charged $89 for a two-minute appointment is ridiculous."
She has reluctantly resorted to telehealth as finances are "tight", but fears it will not be a suitable level of care long-term.
Bulk billing 'unsustainable'
The Australian Medical Association's Rural Doctor Council chairman Ian Kamerman described the current system as "unsustainable", with the collapse in bulk-billing attributed to "years of neglect by federal government".
"The fact that the rebates haven't kept pace with the actual cost of providing the service means that bulk-billing is now much less accessible," Dr Kamerman said.
He called for increased remuneration to encourage more medical students to choose general practice as a specialty to fill the shortfall in the rapidly-ageing and shrinking existing workforce.
"The issue often in regional and rural areas is simply because of the shortage of GPs and doctors out there, all of whom are highly skilled to be able to work out in the bush," Dr Kamerman said.
"It just means there are very few alternatives other than going to the emergency department."
A system 'hostile to primary care'
Back in Bellingen, Dr Hamill said the government could ease the pressure on primary care by reducing the Medicare safety net for concession card holders, or removing the $7 billion private health insurance rebate.
Dr Hamill said she had not seen any evidence that the Albanese government had any motivation to change the current system, which was "essentially quite hostile to primary care."
"There doesn't seem to be any appreciation of the value that we provide in preventative care, in early detection, in managing huge amounts of mental health in the community, in allowing people to avoid hospital presentations," she said.
Dr Hamill believes her time as a GP will be limited, without changes to the system.
"I don't think I will be running a practice in five years' time — because I don't believe that people should be charged for an essential human right which is healthcare," she said.
In a statement, the federal Health Minister Mark Butler blamed the former Coalition governments for inducing the system's slow decline with "cuts and neglect".
He said he planned to "continue to engage with all health care stakeholders, including consumer groups, unions and doctor groups to ensure we make it easier for Australians to see a bulk-billed doctor and deliver our reforms to strengthen Medicare".
