Statistics highlight inequality in bulk billing

Tuesday, 18 April, 2023

Statistics highlight inequality in bulk billing

New figures show an insufficient Medicare rebate has made health care in Australia increasingly inaccessible, the Royal Australian College of General Practitioners (RACGP) said.

A new report by health directory Cleanbill has found 35.1% of surveyed general practices are bulk billing all new patients following years of freezes and low increases to the Medicare patient rebate.

The RACGP stated this has been compounded by growing concern about the increased payroll tax burden on practices from the inclusion of tenant GPs’ earnings in clinics’ taxable wages.

Cleanbill reportedly contacted all 6363 listed general practices in Australia, and enquired if practices were taking new patients, if they would be bulk billed for a standard consultation (Medicare item 23) and the price if bulk billing was available. Data were grouped by electorate and state or territory.

Based on data from practices that responded, Cleanbill reported that Tasmania and the ACT have bulk-billing rates for all new general practice patients of just 6.9% and 5.5% respectively. New South Wales leads the nation at 49%.

Four electorates — Fairfax in Queensland, Franklin in Tasmania, Newcastle in NSW and Mayo in South Australia — were reported by Cleanbill as having zero practices bulk billing all new patients. A further seven had only one in the report. Altogether, 44 electorates — around a third of federal seats — reportedly had five or fewer clinics that could offer bulk billing to all new patients.

RACGP President Dr Nicole Higgins said the results showed the cost of years of neglect of general practice.

“Medicare has not kept up with the cost of running a practice, and we are now well past the point where the general practice profession just can subsidise care,” she said.

“This is the result of years of neglect. In February, new Department of Health data showed bulk billing had fallen to its lowest point in a decade.

“General practices already pay payroll tax for their employees including nurses and receptionists. The added burden of extra payroll tax will only add to the problem. This Sick Tax might boost state revenue, but it’s ultimately patients who pay.

“This is an equity issue, and the government must act to save fair access to health care in the upcoming budget. The government can’t address this without substantially increasing the Medicare rebate and tripling the bulk-billing incentive.

“But we also need a health system that is fit to manage Australia’s aging population and increasing rates of chronic conditions. That means giving GPs the resources to see patients for longer to address their complex health needs, from mental health challenges to menopause. Now, a consultation receives a lower rebate the longer it continues. This penalises GPs who see patients with chronic conditions and multimorbidities, and it needs to change.

“GPs want to serve their communities fairly and ensure all their patients can access the care they need. When people can see their GP when they need to, rather than when they can afford to, they are less likely to experience expensive hospital emergency presentations and [more likely] to be healthier and happier at every stage of their lives. We need a system that supports this.

“GPs have sacrificed for years to maintain access to health care for their most vulnerable patients, but as we’ve seen with recent practice closures, once a practice is no longer financially viable, it has no choice but to close. It’s simple: GPs can’t afford to subsidise Medicare anymore.”

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