Many Australian patients won’t see their doctors return to bulk billing despite incentives introduced by the Albanese government, GPs have warned, while experts say more measures are needed to help disadvantaged, chronically ill people.
Patients who are bulk billed do not pay anything for their consult, with GPs billing the government directly through Medicare instead.
As of Wednesday, GPs began receiving triple the government rebate to bulk bill concession card holders and children under 16 for most standard consultations. The incentive has risen from $6.85 to $20.65 in metro areas, and from $13.15 to $39.65 in very remote areas.
The federal health minister, Mark Butler, said on Wednesday at a press conference announcing the start of the incentives that he had heard from general practices that had moved away from bulk billing that “they were intending to return to bulk billing” due to the increased rebate.
“And for those feeling a need to reconsider their ongoing bulk billing practices, they’ve reaffirmed their commitment to do it in the long term,” he said.
The president of the Royal Australian College of General Practitioners, Dr Nicole Higgins, said: “We expect we’ll see an increase in bulk billing for children, pensioners and healthcare card holders, and also veterans, but it’s unlikely to result in an increase in bulk billing for other types of patients.
“All practices make their own decisions on billing,” Higgins said. “It’s a start, but what’s needed is greater investment in general practice, which is a cost-effective part of our health system.”
A poll on the RACGP’s website asked GPs: “Is your practice changing its billing approach this week, with the start of tripled bulk billing incentives?” Of the respondents, 72% had answered “no” as of Thursday afternoon. The proportion who answered “yes” was 15%, with the remainder “unsure”.
A GP working in rural NSW told Guardian Australia: “As a practice, we are not planning on changing our billing practices.
“[Moving] to a more private billing model took a considerable amount of effort to change culture and patient expectations and [their] sense of entitlement [to have their visit bulk billed],” he said.
“I am concerned that if we go back to bulk billing and undo the hard work we have done, when funding once again fails to keep up with inflation we will need to stop bulk billing again and go through the re-education and abuse again.”
Meanwhile, the Australian Medical Association on Wednesday recommended doctors raise their fees for a third time in 2023 to keep pace with rising costs, increasing the costs of non-bulk billed appointments.
A manager of a general practice in Sydney’s south told Guardian Australia that there were many vulnerable patients who do not meet the criteria for the bulk billing incentive, including young people over 16.
“As a result of this, we are still having to continue with privately charging a significant number of patients,” she said.
“We know for a fact that many young people are deliberately not seeking necessary medical attention because they can’t afford to pay a private consultation fee. This concern will only continue to be perpetuated through the current, restrictive triple bulk billing incentive criteria.”
The health program director at the Grattan Institute, Peter Breadon, said while the bulk billing incentive increase was likely to help slow and, in some areas, reverse the decline in bulk billing, other policies were needed.
“We’ve argued for a blended funding model that has more funding for patients with complex health needs, and who have lower incomes,” he said.
“If it’s designed well, this would help increase bulk billing for people who need it most, including those who don’t have concession cards but still struggle to pay fees … many of which are in disadvantaged areas where bulk billing is needed most.”
