Gap widens between GP and non-GP MBS funding

The latest data shows Medicare pays for 85% of GP services, but just over half of non-GP specialist services.

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The percentage of GP services funded by the MBS has dropped to its lowest level since 2003, while Medicare pays for fewer and fewer specialist services, data from the Australian Institute of Health and Welfare shows.

Nationally 85.1% of GP provider fees were paid by Medicare in April of this year, down from a peak of 95.2% at the height of the covid pandemic in April 2020.

While the GP numbers have remained comparatively steady since data started to be collected in 1984 the story is vastly different for specialist fees.

From a high of 88.0% in October of 1984, Medicare now pays for just 53.5% of specialist services, with out-of-pocket costs falling increasingly on the shoulders of patients.

Obstetric services are the most expensive for patients with an MBS-funded proportion of just 38.3%, with anaesthetics not far behind on 38.6%, and 49.1% of surgical services paid for by Medicare.

Pathology is the cheapest for patients, in terms of out-of-pocket costs, with a subsidy rate of 94.3%, followed by diagnostic imaging (85.6%) and general practice (85.1%).

Out-of-pockets for GP services are highest in the ACT and Tasmania, where Medicare pays for just 69.4% and 78.8% of services, respectively. New South Wales tops the list of subsidised GP care at 87.8% of MBS funding.

Charles Maskell-Knight, a health policy expert, told The Guardian the average subsidy rate “masks a lot of variation” by type of speciality and service.

“The overall average is dragged down by in-hospital services such as operations and anaesthetics, where private health insurance rebates will make up some of the gap,” he said.

He said the biggest policy concern should be specialist attendances.

“The chart of subsidy rate over time shows a steady and sustained decline ever since Medicare began,” he said.

“While there has been a lot of policy work and money put into solving the problem of access to GP services, access to specialists is just as problematic. There are often long waits to a first appointment, and this data shows substantial uninsurable gaps.”