Finally, some clarity on bulk-billing

While politicians debate the finer points of bulk billing, the reality is patients are paying more

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Less than two-thirds of patients are being fully bulk-billed for GP visits and the rest are paying sharply higher costs to see a doctor. 

For the first time, the federal health department has disclosed bulk-billing data that backs doctors’ fears about the Medicare rebate freeze eroding access to healthcare. 

The department revealed last week that only 64.7% of patients were routinely bulk-billed by their GPs in 2015-16.  

The information came to light in responses from bureaucrats, including Health Secretary Martin Bowles, who took questions on notice from a Senate committee hearing on October 19. 

The answers also revealed a sudden jump in patients’ out-of-pocket costs. Patients’ gap fees leapt by 5.4% in the year to last June, nearly five times the rate of inflation, after years of growth in the 2% range. 

RACGP President Dr Bastian Seidel said attention should focus on affordability rather than bulk-billing rates.  

 “What matters to our patients is whether or not they can afford a co-payment for the clinical care of themselves and their families,” he said.  

“We know that financially vulnerable patients will delay seeing their GP if they are faced with increased out-of-pocket expenses, and they will eventually call an ambulance or present to emergency departments at a much greater cost to the taxpayer.” 

Frustrated by the lack of transparency around bulk-billing, the College undertook an independent snapshot of GP activity earlier this year and came up with a bulk-billing figure of 69%. 

On the official count, only 1.3% of GPs did not bulk bill any services, down from 3.2% in 2005-06. But most GPs (85.5%) bulk-billed more than half their services, up from 74% a decade earlier. 

On the same October day as the Senate grilling of her most  senior bureaucrats, Health Minister Sussan Ley said the official 85% bulk-billing rate, based on services rather than patients, was all that mattered.  

 “The only figure that matters here is the bulk-billing rate. Now that is simply drawn from Medicare data; it is the evidence,” Minister Ley told reporters in Canberra. 

“Other figures that swirl around from time to time may be in the interests of those making the arguments. But what I focus on is the bulk-billing rate, and it has never been higher.” 

Dr Seidel said bulk-billing numbers had been subject to political spin for too long. 

The government had used its statistics to justify the freeze on Medicare rebates, but they were not truly reflective of bulk-billing rates, Dr Seidel said. 

“For the first time we now have access to data regarding how many general practice patients – as opposed to services – are bulk-billed every year,” he said.

Dr Ewen McPhee, President of the Rural Doctors Association of Australia, said the debate about bulk-billing was only important in the minds of Liberal and Labor politicians.  

“The whole debate about bulk-billing rates is a complete furphy.  It detracts from the important conversations we should be having,” he said. 

Politicians on both sides focused on bulk-billing because they were  out of touch and avoiding the hard questions, Dr McPhee said.  

“We desperately need to understand where we are going with a whole bunch of things –such as the MBS review and Health Care Homes. 

” Is (the agenda) just an effort in cost savings, or are we trying to promote primary care and increase capacity?”