Fewer than one in four Australian general practices provide bulk billing to all patients, with more than 500 clinics switching to private billing in the past year, according to a new report.
Online healthcare directory Cleanbill on Monday released its Blue Report providing data on the rates of bulk billing – where the full cost of a consultation is paid for by Medicare without any additional gap fees – across 6,818 practices.
The data in the report was collected after the tripling of the bulk billing incentive for concession card holders and children under 16, and the final indexation of Medicare rebates for 2023 on 1 November, and then compared with the data from the same clinics collected before April 2023.
The report found the rate of bulk billing nationally had dropped by more than 11% from 34.7% in 2023 to 23.6% in 2024, with 514 clinics that bulk billed all patients at the start of the year having stopped offering it by the end.
Out-of-pocket costs have risen to $41.69 on average across the nation, with the highest costs in Tasmania, where patients face $51.19 on average a visit, according to the report.
Consistent with the exclusive data Guardian Australia’s investigation revealed last year, it found the southern-most state also had the lowest rate of bulk billing, with less than 1% (0.9%) of clinics offering bulk billing to adults.
New South Wales had the highest rate of bulk billing, with 37.2% of clinics not requiring adults to pay out of pocket, according to the report.
James Gillespie, the founder of Cleanbill, said the organisation collected its data by calling every general practice listed across the country and enquiring about the cost of a visit for a new adult patient without any concessions on a weekday.
“This is really the first report that has asked every single GP clinic across the country what it charges and tracked it year by year,” Gillespie said.
The latest statistics from the government’s September quarter report, based on the proportion of all services that are bulk billed rather than the proportion of clinics or providers that bulk bill all patients, show 73.2% of all standard general practice consultations were bulk billed. It increased to 86.8% for patients living in the areas of highest socio-economic disadvantage.
The health minister, Mark Butler, said “the Albanese government’s tripling of the Medicare bulk billing incentive is targeted at those Australians who feel cost of living pressures most acutely.”
Butler also highlighted the Albanese government’s delivery of 58 Medicare urgent care clinics which are operational around the country, and open for extended hours, over weekends, for walk-in care that is fully bulk billed.
Melissa Le Mesurier, a director at the Consumer Health Forum, said Cleanbill’s 23% figure referred to practices that bulk billed all their patients but that based on other reports – such as from the Royal Australian College of General Practitioners – nearly 75% of practices offered some form of bulk billing to some or all of their patients.
“The timing of the report does not reflect any increase in bulk billing since the federal government introduced a range of incentives for practices to do so on 1 November 2023, as well as the establishment of urgent care clinics which fully bulk bill,” Le Mesurier said.
“No matter the true figure of general practices fully or partially bulk billing their patients, the fact remains that consumers are telling us that with the rise in cost of living, they are finding it more difficult to afford to access the healthcare they need.”
Le Mesurier said data that came out at the end of last year from the Australian Bureau of Statistics’ recent patient experience survey also showed more consumers were delaying or putting off entirely receiving healthcare because of cost.
The peak body for GPs, the Royal Australian College of General Practitioners (RACGP), said the data reflected the cost pressures on general practice in an inflationary environment which are driving up costs for patients.
Dr Nicole Higgins, president of the RACGP, said while the government’s tripling of bulk billing incentives has helped more GPs bulk bill the specific concession groups targeted, more needed to be done to ensure care is affordable for the rest of the population.
Higgins called for more investment in what she said was the most cost effective health service, “with a 20-minute GP consult costing about $40, whereas a visit to hospital costs over $600, and much more if a patient is admitted”.
The commonwealth health department and the health minister were contacted for comment.
