It’s getting harder and harder to find a bulk-billing doctor — and it’s even harder to discern their fees. New analysis, which involved calling scores of GP clinics across the country to determine their billing practices, has found just 4% of clinics in the ACT and Queanbeyan offer bulk billing. Analysis into other states is still underway.
As revealed by The Sydney Morning Herald this morning, rates of medicare fraud are staggeringly high, costing the taxpayer up to $8 billion a year. As inflation bites the few clinics that legitimately offer bulk billing, services will continue to dwindle, experts warn, arguing the Medicare rebate is simply not enough to cover costs.
Billing transparency is muddy
Cleanbill is an online resource that aims to publish the pricing of practitioners across the country. Founder James Gillespie and a small team have, through both automated processes and the laborious task of calling individual clinics, collected pricing, location and contact information of healthcare practitioners.
The organisation found that of the 100 clinics in the ACT and Queanbeyan (all but one provided a pricing quote), just four offered bulk billing. The average out-of-pocket cost for a standard consultation was $48.92, while longer consultations averaged out at $66.65.
“The national-level studies you need to do to prove [bulk-billing rates] empirically requires just an enormous amount of work,” Gillepsie told Crikey.
Gillespie’s research began in 2018 when he highlighted the “postcode lottery” of bulk-billing practices. His prior research didn’t elicit much response from the government, but he hopes this time will be different.
“The national feeling around bulk billing is very different now to what it was four years ago [when] people weren’t as worried about the cost of living and bulk-billing rates as they are now.”
According to the Royal Australian College of General Practitioners (RACGP) Health of the Nation report, just 24% of GPs bulk bill all of their patients, while this past financial year has seen a fall in the proportion of GP services bulk billed for the first time in almost 20 years.
Australians made more than 500 million trips to the doctor last financial year. But as revealed earlier this year, as few as 30% of patients were being properly bulk billed, with some practices illegally collecting a separate out-of-pocket cost, but listing the service as bulk billed through Medicare.
Clinics ‘struggling to survive’
Cornerstone Health CEO Henry Bateman — whose healthcare company establishes large-scale bulk-billing clinics across the eastern states — told Crikey the trend away from bulk billing had been noticeable since April as inflation worsened. Cornerstone Health is also feeling pressure to implement a co-payment due to the low Medicare rebates.
“We’ve had this huge influx of patients into our practice as all the practices in the neighbouring areas have largely stopped bulk billing,” he said, pointing to Loganholme in Queensland, Williams Landing in Victoria, and Penrith in NSW as key areas of concern.
“I speak to lots of doctors outside of my own network. And they just say, ‘No, we can’t financially survive anymore. We can’t carry the cost anymore.’”
From a business perspective, increased demand should be a good thing for Bateman. But soaring inflation and staff shortages are biting Cornerstone Health too.
“We’ve got the benefits of being a bigger group and the benefits of scale, so the costs are shared across a large number of doctors. But everyone has their breaking point,” Bateman said.
He said there’s been a surge in demand for nurses to administer COVID-19 and influenza vaccines, but while they were rightly paid a premium for their work, that premium saw a 25% increase in costs over the past four months.
The increasing cost of supplies coupled with extreme staff shortages — caused by staff getting infected with COVID-19 or the flu, career burnout, and a shortage of students entering the industry — things had been brutal.
“It’s a pretty acute moment,” Bateman said.
‘Morally hazardous’
Queensland chair of the Royal Australian College of General Practitioners Dr Bruce Willett told Crikey issues had been longstanding since the Medicare rebate freeze from 2013 to 2019. It means some medical professionals are being reimbursed the same amount this year as they were in 2014. He said getting payments from patients was a massive stressor for doctors.
“I’ve had some patients for 30 years. But particularly for aged care pensioners, co-payments are a significant amount of their pension so I can’t ask them to do that,” he said, adding it was “morally hazardous” for doctors to pressure patients into new co-payments.
“On the other hand, I can’t afford to attract more patients because the ones I have tend to be quite high-needs. So that stress … is contributing to that massive increase in burnout [among practitioners].”
Official Medicare data states that the national bulk-billing rate is 82.2%, which takes into account all tests, checkups and trips to the doctor, and doesn’t account for fraud. Federal Health Minister Mark Butler announced $750 million towards a Strengthening Medicare Fund this year, but details of how the funding will be spent haven’t been announced.
Have you struggled to find bulk-billings GPs? Let us know by writing to letters@crikey.com.au. Please include your full name to be considered for publication. We reserve the right to edit for length and clarity.
