The number of Australians who are fully bulk billed by their GP has dropped significantly in just three years, with one electorate experiencing a decline of 18%, a Guardian Australia investigation reveals.
Experts say the decline of bulk billing – where the full cost of a consultation is paid for by Medicare without any additional gap fees – is putting serious strain on overstretched emergency departments and other health services.
Data obtained exclusively by Guardian Australia reveals a 4% decline across the country, with a far bigger drop in some areas, including the northern suburbs of Perth, the Central Coast of NSW and areas between Brisbane and the Sunshine Coast in Queensland. In Western Australia there was a decline across all electorates between 2019 and 2022.
The most pronounced drop was seen in the two northern Perth electorates of Pearce and Moore.
In Moore, which includes the suburbs of Joondalup and Stirling, 58.4% of patients had all appointments bulk billed in 2019-20. By 2021-22 that had dropped to 47.9%. This represents a decline of 10.5 percentage points, or an overall decline of 18%.
Donald Smith*, a self-employed 62-year-old who lives in Joondalup, said he is not surprised by the figures. In 2021 he had several advanced skin cancers removed and was told that ongoing monitoring is crucial. But he is “deliberately avoiding” his annual full-body skin check with his GP, who stopped bulk billing 18 months ago.
If Smith were to book the extended consultation he needs for a skin check, he would be $66 out of pocket. “When I compare that with where my income is at the moment, then that is an issue,” he said.
“It worries me that we’re heading towards an American healthcare system which basically, you know, if you’re dying but you can’t afford [healthcare], they’ll just push you out into the street and say, ‘Sorry, we can’t help you.’”
Charles Maskell-Knight, a health policy expert and a former senior public servant in the commonwealth Department of Health, analysed the data for Guardian Australia and said the overall decline in bulk billing had important implications for demand on hospital emergency departments.
“If patients with limited resources are not sure they will be bulk billed if they go to the GP, they are likely to seek care elsewhere,” he said.
Some patients ‘not even making it to consult’
Previously, GP bulk-billing rates by electorate were only available up to the 2018-19 financial year. In August 2022 Guardian Australia asked the Department of Health for the same data to the end of the 2021-22 financial year but was referred to Services Australia. After a lengthy request process, the data was provided last week.
The chair of community health and wellbeing at the University of Queensland’s school of public health, Prof Lauren Ball, said because the electorate data only captures those who were able to see a GP – the many Australians who say they can’t even get a bulk-billed GP appointment in the first place are not represented.
“If someone turns up needing support and is informed there’s now a gap they have to pay and goes elsewhere, such as a hospital, that’s all missed here in this data,” she said. “They’re not paying a gap or being bulk billed because they’re not even making it to a consult.”
Ball said while there were 36 electorates where there was a meaningful increase in bulk-billing rates over the three year period – she determined an increase of 2% or more to be significant – this is likely due to a rise in bulk-billed services such as for PCR tests, vaccines and telehealth appointments during the Covid-19 pandemic.
How Covid obscured the numbers
According to separate Department of Health analysis provided exclusively to Guardian Australia, the 24m bulk-billed Covid vaccines in the 2021-22 financial year inflated the proportion of people who had all their GP visits bulk billed by 1.5 percentage points.
Excluding bulk-billed Covid vaccines, the analysis shows the proportion of patients who were always bulk billed at the GP fell from 67.5% in 2020-21 to 64.3% the following year – at the same time the former government was claiming bulk-billing rates were at a “record high”.
The analysis was provided by the office of the health minister, Mark Butler, after Guardian Australia obtained the bulk-billing figures by electorate from Services Australia.
Asked why the data was not regularly released and whether his government would commit to publishing it from now on, the health minister said from 20 February all bulk-billing data will be made public.
He said the Department of Health would regularly publish the updated methodology for determining bulk-billing rates, along with a geographic breakdown by primary health network, rather than electorate, as this would more accurately reveal the care needs of communities.
“The previous government hid the shocking decline of bulk billing during its term of government, but I’m releasing the data so Australians can see for themselves,” Butler said. “Being transparent with the public is the first step.”
*Surname changed to protect privacy
