Bulk billing plummets outside capital cities

The disparity is most striking in NSW, with almost 50% of clinics bulk billing in Sydney and only 13% in the rest of the state.

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The likelihood of finding a doctor who will bulk bill a non-concessional adult is much lower outside capital cities in most states, a new Cleanbill report has confirmed.

The report, published today, analysed data originally published in Cleanbill’s Blue Report in January on the state of bulk billing across the country for adults without concessions who are visiting a GP for a standard consultation (item 23).

“One of the biggest questions that I got asked when the Blue Report came out was, ‘we’ve got this state-level data but how does that state-level data break down within each state?’,” Cleanbill CEO James Gillespie told The Medical Republic.

According to Cleanbill, the results of the granular breakdown are “deeply concerning” as bulk billing rates outside capital cities are generally lower than rates within them.

While capital cities had an average bulk billing rate of almost 29%, this dropped to around 16% for any area outside the capital cities.

The metro/regional disparity was most notable in the state with the highest overall bulk billing rate: NSW.

“In the Blue report, NSW had a really, really high bulk billing rate, at least comparatively to the rest of the nation, at 37.2%,” Mr Gillespie told TMR.

“But I had a strong feeling, based on the data that we’d already seen last year for NSW, that once we broke that down within the state, it would show that that a large proportion of those clinics were concentrated within Sydney.

“And that’s what we’ve now seen.”

While almost half of all GP clinics in Sydney bulk bill all non-concession adults for an item 23, this drops “dramatically” to 13.3% in the rest of NSW, said Mr Gillespie.

There were also disparities in the average out-of-pocket costs between capital cities and surroundings, with higher costs outside of capitals.

While the average national out-of-pocket cost was $40.62 in capital cities, this rose to $43.05 outside of these cities.

The starkest margin was seen in WA.

“Western Australia was a really, really interesting state because you had a higher bulk billing rate outside of Perth than within Perth, which was unusual,” said Mr Gillespie.

“But if you are going to see a GP outside of Perth, and you’re not going to see a bulk billing GP, the average out of pocket cost for a standard consultation is significantly higher – $5.50 higher on average – than if you were going within Perth,” he noted.

While these data “may appear dire” on the face of it, bulk billing, or below-average-cost, GPs are present in most communities, it’s just hard to find them, said Mr Gillespie.

According to the report, a quarter of GP clinics don’t have a website.

Of those that do, only one in 10 has pricing information online and less than 1% display availability, said the report.

“Faced with these information barriers, it’s easy to see why over 1.2 million Australians per year delay or forego care with a GP in their community because of concerns surrounding cost,” read the report.

“These Australians almost inevitably end up in public hospitals.

“This should not be happening.

“If out-of-hospital primary healthcare is to be accessible for all Australians, a service that helps people find available doctors who they can afford around them is no longer a luxury; it’s a necessity.”

Data from the ACT was omitted as “the ACT does not have a split between a Greater Capital City Statistical Area and the rest of the Territory” and from the NT as “there were too few clinics here for further meaningful analysis”, noted the report.