Apples, oranges and bulk-billing statistics

DoHAC says bulk billing is up. Mainstream media says bulk billing is down. Both are technically correct.

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You might have noticed that bulk-billing statistics don’t make sense.  

On one hand, Health Minister Mark Butler and the Department of Health and Aged Care have statistics showing a 3.4 percentage point rise in the GP bulk-billing rate over the six months following the tripled incentive being put in.  

But on the other hand, as pointed out in The Daily Telegraph today, the same dataset can also show that bulk billing is down by 4 percentage points. 

Both statements are technically true; the difference is in the start and end points.  

Mr Butler’s count is anchored at the GP non-referred attendance bulk-billing rate in October 2023, one month before the tripled bulk-billing incentive was implemented.  

His baseline, therefore, is the point-in-time rate of 75.6%.  

By his maths, the May 2024 bulk-billing point-in-time rate of 79% means an increase of 3.4 percentage points over six months.  

The Telegraph appears to have based its analysis on the Medicare quarterly statistics dataset and is instead comparing the average bulk-billing rate from the previous financial year to the average bulk-billing rate for the current financial year (up to the March quarter).  

Not only did the newspaper measure from a different point to DoHaC, but it did not have the most up-to-date end-point figure; to be fair, these were not published by DoHAC until after the article ran.  

The average bulk-billing rate in the last fiscal year, which spanned mid-2022 to mid-2023, was 80.2%. The average bulk-billing rate for the first three quarters of this financial year was 76.7%.  

This gives the far less flattering result of a net bulk-billing decrease of 3.5 percentage points spread over two years. 

It is, however, worth noting that because the fiscal year starts in July, the averaged 2023 financial year statistics capture the second half of 2022, at the tail end of the pandemic.  

“There was an artificial inflation, if you like, in the number of short visits to the doctor to get those bulk-billed vaccinations for covid,” Mr Butler told Today this morning.  

“There were tens of millions of them, and obviously we’ve moved beyond that.”  

The other problem with using the averaged financial year rate is that the bulk-billing incentive did not go live until November, in the middle of the first 2024 quarter.  

According to PhD candidate and Menzies Institute health economist Luke Slawomirski, the fairest way to slice it is to compare the 2023 March quarter average with the 2024 March quarter average.  

These figures are 78.1% and 77.1% respectively, meaning that the average GP bulk-billing rate has decreased by 1 percentage point over the last 12 months.  

Theoretically, using just the 2023 March quarter data eliminates the contaminating factor of covid vaccines that artificially inflated the average for the whole year.  

Whether the bulk-billing rate decreased by 3.5 percentage points or increased by 3.5 percentage points or decreased by one percentage point, Mr Slawomirski said the main takeaway should be that the tripled bulk-billing incentive was hardly groundbreaking.  

“The incentive is not really touching the sides, by the looks of it,” he told The Medical Republic.  

“A 3% increase is next to nothing compared to the need that’s out there.”