The problem with ‘record-high’ bulk billing rates

The problem with 'record-high' bulk billing rates

According to government data, bulk billing rates are at an all-time high: around 85% of GP services are bulk billed. This figure is often used to justify the lack of investment in general practice, including the freeze on Medicare rebates patients get back after a visit to their family doctor.

Why is this figure so high? Not surprisingly, the issue is more complex than politicians want us to believe.

According to the government it is a matter of supply and demand. In other words, they claim that GPs will not be able to introduce a fee because their patients would go to a bulk billing practice down the road.

This argument, as well as the government’s focus on record-high bulk billing figures, is misleading and doesn’t tell the whole story.

The truth about BB rates

The reality is that we don’t exactly know why bulk billing levels are high. There are several possible explanations, such as:

  • GPs have been billing compassionately to provide access to all their patients
  • GPs have been absorbing the costs of the government’s freeze on patient Medicare rebates
  • Doctors have increased their services to compensate for the low Medicare rebates
  • As a result of the ageing population more people are bulk billed.

The explanation given by the government that market forces are the reason GPs bulk bill does not do justice to the work of GPs around the country. Besides, as a result of government policies, out-of-pocket expenses for patients have been rising over the years.

Why out-of-pocket costs go up

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Image: As a result of the Medicare freeze on patient rebates, GP practices across Australia are getting ready to introduce fees. Source: Twitter

GPs are genuinely concerned about their patients first and foremost and, no matter what politicians say, GPs have been bulk billing a large proportion of their services because they know that many patients would not seek medical care if they had to pay a fee of $15-$20 per visit.

Unfortunately the government has indicated it will not further index Medicare patient rebates, and as result of the government’s long-term Medicare freeze, practices across Australia will be forced to introduce fees.

This was the whole idea behind the government’s original co-payment plan and the reason the Medicare freeze has been dubbed a ‘co-payment by stealth‘.

The short-term ‘savings’ created by the Medicare freeze will likely result in more health problems due to delayed GP visits, and drive up costs in the longer term. A typical case of a penny wise and pound foolish approach.

Downward spiral

What if practices don’t introduce a fee? A bare-bone, high-turnover model is one way bulk billing practices can sustain themselves: doctors may decide to see 7-8 patients per hour instead of 4-5. The question is of course: how safe is this and how long can they keep doing this?

High bulk billing rates, yes – but is this the health care system we want for Australia?

Out-of-pocket costs comparison

The focus on high bulk billing rates is misleading as it only tells part of the story. At the same time Australians pay more out-of-pocket for medical care than many other countries, which creates barriers to visiting a family doctor. Source: RACGP

The bulk billing statistics tell us what percentage of services is bulk billed, not patients. We also know that Australians already pay more out-of-pocket for their care than many other countries, which creates barriers to visiting a family doctor. These figures are rising, so clearly the bulk billing statistics only tell part of the story.

Instead of looking at bulk billing rates as a measure of success, we should be carefully monitoring the out-of-pocket health expenses in Australia.

GP Leaders have warned that we’re facing a downward spiral – which is a risk for the nation’s health and leads to higher overall costs. Even if the freeze on Medicare patient rebates is reversed – which is an absolute must – we’re not out of the woods.

We need well-resourced, sustainable primary care funding models that support high quality care for our patients and are easy to implement at grassroots level.

Follow me on Twitter: @EdwinKruysDisclaimer and disclosure notice.

20 thoughts on “The problem with ‘record-high’ bulk billing rates

  1. The problem I found with bulk-billing practices is that they are usually clinics with several GP’s, and also have a model of no appointments. This leads to waiting around sometimes for hours, and I have also seen a sign on the door of one such practice saying that they would be taking no more patients that day because their time slots were all full – and this was at 9.30 am.

    The other thing, of course, is that to optimise doctors’ time you can’ t ask for a particular doctor. While this is not a huge problem most of the time, you will find that often the doctor you see is not familiar with your case, and this is inconvenient for patients with chronic conditions

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  2. Times are tough But preventative medicine should be actively encouraged and this Freeze reversed [Only by all the experts opinions I read] It should not be assumed for convenience of processing that all Aged Pensioners need to avail themselves of bulk-billing – How? Perhaps a quarterly review of the ceiling afterwhich it looks likely the year ahead that they will fall back into that category. Or some similar adjustable system. I read once that economic fixes are always running years behind the need to apply them

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  3. In Launceston, I pay $48 out-of-pocket for every visit to see a GP in the local medical centre. Even pensioners still have to pay – $30!! To get an appointment at a bulk billing medical centre (there are only 2 here, as far as I could ascertain) is next to impossible.

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  4. We are running a RACGP practice workshop next weekend in Perth for aspiring owners and existing owners, this wil be a hot topic of discussion.

    High quality care is just not sustainable in a bulk billing model. Volume and long hours of work will lead to burnout in our profession and from a business perspective, more practices closing their doors.

    It’s interesting, all the patients that I bulk bill because of their financial status and chronicity of medical issues, require the most work with respect to intellectual application, administration and consulting time.

    Great piece Ed, you are a voice of reason for our profession. Thank you.

    Liked by 1 person

  5. I visit a local Primary Care practice. I also have Type 2 diabetes. At this practice I am bulk billed. I see a general GP as well as a GP with a particular interest in diabetes. She has access to an Endocrinologist in the practice in case she needs a second opinion and I am not charged for this service.

    I also see a podiatrist under a care plan every 10 weeks and a diabetic nurse at about the same interval. There is also a diabetic educator to whom I report my blood sugar readings every week. She changes my doses of insulin if necessary. There is also an Ophthalmologist if I need them.

    My friends cannot believe I am receiving such comprehensive care with no outlay. As a disability pensioner I could not afford to continue to pay for private specialists. My former Endocrinologist left me with out of pocket expenses of $200 per visit and my Ophthalmologist even more.

    Why can this centre operate so efficiently when others cannot even provide basic GP services?

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  6. I have complex needs, with multiple diagnosis. There is no such thing as a quick visit for me, there’s just too much to cover at each appointment. But as I am on a pension I don’t have the money to pay for out of pocket expenses. This would leave me with no option but to wait until my condition deteriorates to the point where I can go to the hospital. How is this more cost effective.

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  7. The Non VRs and the Government have put together a package that gives GPs a $60k pay rise plus ends the freeze. Meanwhile, the RACGP has spent over a million dollars telling everyone in the country that Non VRs are not good GPs, and then spent over a million dollars telling everyone the rebate freeze was the government’s fault, and by implication, not to vote for them in the upcoming election.
    I say it is time to end this madness.

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    • Hi what is aVR please and the another acronym.

      I am interested in learning both sides of the debate.

      I am suppose to see my doctor regularly as I have a blood condition, although it’s better and I am managing it, I should get regular check ups. The issue was it costs me $60 as that clinic was brought out by some corporation.

      But it stops me getting my check ups as I can’t afford it. I work too, but the cost of living is so high in NSW that it hits me.

      I have no issues paying for my health care but then I shouldn’t have to pay tax.

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  8. We need to stop this now. Medicare rebates to GPs before the freeze only rise by the CPI which we all know is not a fair indication of the real cost of living increases. The government knows this. The taxes they take in the form of the Medicare tax is not increasing by the CPI nor is it being frozen. So what does the government intend to do with the extra money it’s making on the Medicare taxes. Mr Turnbull we are not as stupid as you think. That was Mr Abbott’s greatest mistake, don’t make it yours.

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  9. I came to this site hoping to read a clear argument with facts and figures why the Government’s line on 85% bulk-billing rates is so deceptive. I have read the essay or blog, and am still none the wiser. I see a box comparing Australian out of pocket expenses to see a GP as 20% vs 13% in NZ, 14% in Canada, and 10% in the UK. I have no idea what these figures are supposed to mean, or how they are arrived at. @0% of what? And if 85% of consults are bulk-billed. I need to see the case well argued that the out of pocket costs paid by Australian patients are so grossly misrepresented by Government’s “85% bulk-billing rate”.

    I do think the freezing of Medicare rebates for medical consultations is a retrograde step. I am astounded by the 85% figure the Government cites. Is this a lie? or otherwise deceptive? Plese show it if you think so.

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  10. The crux of the matter is – The LNP want to GET RID OF MEDICARE, and this is just the beginning. We, as a Nation, have to fight this – politicians don’t need to worry about their health care as they retire on HUGE PENSIONS and some are already MILLIONAIRES. When they leave politics after making health care worse for those who greatly need it, they won’t give a stuff about the rest of us. They have NO IDEA how the rest of us have to survive.

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    • Extinguishing bulk billing only makes sense if the ultimate goal is to re-introduce medical health insurance (we currently have hospital health insurance, but medical is outlawed).
      When the gap becomes large (50% or more) then the government will magnanimously offer to change the law so we can take out medical insurance.

      Winners: the privatised health insurance industry (incl. some big multinationals), who currently donate a lot of money to (some?) political parties. It may also help the campaign to get rid of Obamacare.

      Why else would the Liberals do this and risk not being re-elected, if they hadn’t promised to do it before the last election? They did make promises which they simply MUST keep.

      Like

    • Extinguishing bulk billing only makes sense if the ultimate goal is to re-introduce medical health insurance (we currently have hospital health insurance, but medical is outlawed).
      When the gap becomes large (50% or more) then the government will magnanimously offer to change the law so we can take out medical insurance.

      Winners: the privatised health insurance industry (incl. some big multinationals), who currently donate a lot of money to (some?) political parties. It may also help the campaign to get rid of Obamacare.

      Why else would the Liberals do this and risk not being re-elected, if they hadn’t promised to do it before the last election? They did make promises which they simply MUST keep.

      Like

  11. We are both Old Age Pensioners. We have a small amount of Super because it wasn’t too fashionable when we were working. At present we still have Medical Insurance although not top cover. We have been with same fund for 40 years. One of us recently had cancer and had to negotiate with the Surgeon over the $5000.00 excess, out of pocket expenses. At present we require a hip replacement and a hernia operation. Neither of which we can have in the Private Sector because of the excessive fees. Labour stopped the gap payments and the Liberals have frozen the Medicare Rebate. The insurance companies don’t care as long as they keep making money so those who cannot afford the gap payments don’t have a hope. Eventually it will be like the USA where only the well off will be able to afford medicine.. And we have to vote for one of them! Chose carefully my friends because whoever gets in it will be a Politician!

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