Falling bulk-billing rates hit working families who don't qualify for concession cards

Michelle Ryan said she and her husband had to start a special bank account to save for regular medical expenses.   (Supplied: Michelle Ryan)

As a person who lives with chronic illness, Michelle Ryan was struggling to stay on top financially when her GP announced they would stop bulk-billing.

The mother of two teenagers has an autoimmune condition called psoriatic arthritis and regularly needs to see a doctor because she takes a medication that weakens her immune system.

“They just notified us one day and we all had to pay,” she said.

“It’s hard because I’m paying $64 every time I see my GP.”

New survey data suggests adults like Ms Ryan are finding it increasingly hard to find a GP that bulk-bills.

The data from Cleanbill, an online directory of GPs, is based on a survey of more than 6,000 clinics across the country, broken down by electorate. Clinics were called at the beginning and end of 2023 and asked whether they bulk-billed new, adult patients who did not hold concession cards.

And the data showed the vast majority of electorates across Australia — 87 per cent of them — saw a drop in clinics that bulk-billed these patients.

There are now nine electorates that have no GP clinics that will bulk-bill new non-concessional patients, up from four at the start of 2023, Cleanbill’s report claims.

It also says there are only nine electorates where more than 75 per cent of GP clinics do bulk-bill this group of patients, and they are all located in Western Sydney.

In some electorates, the percentage of GPs that bulk-bill these patients has dropped by up to 48.5 per cent, the report said.

However, experts and the federal government say Cleanbill’s data does not paint a full picture of bulk-billing rates around Australia.

One piece of the bulk-billing puzzle

Cleanbill’s survey focused solely on adult patients that do not hold a concession card and are seeking a standard consultation at a GP that is taking on new patients.

Children and concession card holders — which includes pensioners, people with disability and low-income earners — were not factored into the data.

Neither were GPs that might bulk-bill their regular patients, even if they are not taking new ones.

Health systems and policy professor Kees Van Gool, who reviewed the data for the ABC, said while Cleanbill’s data provided a useful insight into bulk-billing rates for some Australians, it did not account for a large number of patients.

“People on concession cards are much bigger users of primary care services [and make] higher numbers of claims compared to non concession-card holders,” he said.

“The reason for that is that a lot of concession card holders are elderly — and of course elderly people use more GP services.”

However Anthony Scott, a professor at the Centre for Health Economics at Monash University, who also reviewed the data, said while the data Cleanbill analysed was restricted, it was “clean”.

“The drivers of bulk-billing for people doctors already know or are on low incomes etc are more complicated,” he said.

Cleanbill’s founder James Gillespie said the data was not intended to reflect bulk-billing rates for all patients – but rather shed light on the bulk-billing services available to a typical adult without concessions.

“It still does offer a really, really important insight. That’s a really, really important measurement to have,” he said.

Slowing bulk-billing rates could be picking up

Federal government data also indicates Australians might be finding it harder to find a doctor that bulk-bills.

Medicare data shows that for GPs, the national bulk-billing rate for the July to December period — covering all patients — fell from 82 per cent to 76.5 per cent between 2022 and 2023.

However, the federal government says this decline has been slowed in recent months, particularly in regional areas.

Last November, the federal government tripled the bulk-billing incentive, paying GPs more money to see children and concession card holders — and Health Minister Mark Butler said this was already having an impact.

“The GP bulk-billing rate has risen by 2.1 percentage points in the first two months since the Australian Government tripled the bulk-billing incentive,” he said.

“The increase in the bulk-billing rate means Australians had an estimated 360,000 additional trips to the GP bulk-billed since the tripled incentive began on 1 November.

“The increase in bulk-billing is across all states and territories, with GP clinics around the country making the shift back to bulk-billing.”

Professor Van Gool pointed out that the effects of this new policy may not be reflected in Cleanbill’s data.

Anthony Brown from Health Consumers NSW said the biggest challenge for patients was getting into a new GP, not whether they bulk-billed.

Specialist bulk-billing rates far lower

Health consumer groups told the ABC the real issue was the low rates of bulk-billing among specialists and anaesthetists.

Health department figures show the bulk-billing rate among specialists was 29.2 per cent for July to December in 2023, down from 30.6 per cent the year before, with an average out-of-pocket of $106.71.

The rate among anaesthetists was far worse, at 9.3 per cent, down from 10 per cent the year prior and an average out-of-pocket of $207.86.

Consumers Health Forum of Australia chief executive Elizabeth Deveny said specialist fees hit health consumers much harder.

“All the media coverage is about GPs — but GPs are far more likely to bulk-bill you than a specialist,” she said.

“People don’t know they can ask their specialist to bulk-bill them.”

She said there was now a push for “no name referrals” where GPs write referrals without a specific doctor’s name to encourage health consumers to shop around.

Dr Brown agreed, saying patients were getting bill shock, especially from anaesthetists who they often had no control in choosing.

“There’s lots of people who are putting off seeing specialists because they can’t find any in the public system, particularly in rural areas,” Dr Brown said.

MyMedicare should help the situation, eventually

MyMedicare is a free, voluntary patient registration scheme designed to improve care for the chronically ill.

Under the policy GPs will get triple the bulk-billing incentive for longer telehealth consultations for children and concession card holders and new incentives are expected to be unveiled in the middle of 2024.

At present most GPs have registered and upwards of 700,000 patients have enrolled.