Bulk-billing hope with GP deal to end tax stand-off

Avoiding hip-pocket expenses at the doctor should be easier after GPs and NSW officials brokered a deal to curb crashing bulk-billing rates and end a backroom spat.

But concerns have been raised that the state is scrimping on its health spending despite Tuesday's budget including funding to see off the GP payroll tax dispute.

A court decision over the tax had led to fears more clinics would have to slug patients with gap fees in order to cover the expense.

However, a waiver and new system aimed at rewarding clinics that bulk-bill is hoped to ease pressure on clinics, patients and emergency departments.

"What (doctors) have told us is without this, clinics would close and patients would be billed perhaps $20 per visit," Finance Minister Courtney Houssos told reporters.

NSW has implemented a payroll tax waiver for clinics bulk-billing the vast majority of patients. (Dan Himbrechts/AAP PHOTOS)

The state budget includes nearly $189 million for a scheme to provide payroll tax rebates and to waive doctors' liabilities up to early September.

Queensland and Victoria also implemented changes in their budgets in May but NSW claims its scheme will be the most comprehensive in the country.

Bulk-billing rates across NSW reached 88 per cent during the pandemic but have since plunged to 10-year lows.

A recent survey cited by the state government showed nearly half of adults were cutting back on healthcare appointments due to affordability, while a third of parents were doing the same for their children.

Clinics in Sydney bulk -billing 80 per cent of patients and clinics elsewhere hitting a 70 per cent mark will be spared payroll tax for contractor GPs.

Payroll tax might still be applicable for other workers such as nurse practitioners.

The scheme should stave off further drops in bulk-billing but increasing the number of appointments without a gap was in the hands of the federal government, Ms Houssos said.

Doctors welcomed the change after six years of uncertainty over payroll tax liabilities for GP clinics.

"This gives GPs across NSW certainty that they can continue to operate and keep their doors open for patients, without fear of being hit with a huge tax bill that will shut them down," said Rebekah Hoffman, the NSW chair of the Royal Australian College of General Practice.

But the Australian Medical Association criticised a $31.9 billion health budget that was up less than three per cent on the previous year's figure.

"After health inflation, this is an effective loss," AMA NSW vice-president Fred Betros said.

Opposition Leader Mark Speakman said the state was already seeing the effect of previous hospital expenditure cuts.

"We've seen emergency department waiting times blowout, fewer elective surgeries being undertaken - all because the government is cutting spending in real terms on health," he said.

Some $3.4 billion was set aside for hospital infrastructure including upgrades at Liverpool, Westmead, Port Macquarie, Eurobodalla, Moree, Cessnock and Shellharbour.

Private insurers will no longer get away with paying less than the standard single-room rate in public hospitals, clawing back $490 million over four years.