Labor has made an extravagant (or is it?) promise to lure GPs back to universal bulk billing, but for most it’s not worth it.
We woke to the news on Sunday that Labor will spend $8.5 billion across four years to extend the tripled bulk-billing incentive, projecting this would make nine out of 10 GP visits “free”.
This pre-election promise was quickly neutralised by the federal opposition.
Several GP colleagues took to their social media pages to clarify the details as they stand, namely:
- This will most likely benefit practices that currently bulk bill everyone i.e. universal bulk billing (UBB);
- This may incentivise fast medicine as the biggest boost is for the standard consult from $42.85 to ~$69;
- Mental health, women’s health and complex and chronic care item numbers don’t see the same increase, only 18-30%, despite rising chronic care needs;
- The current AMA rate for a standard consultation is $108, so most GPs who currently bill privately would be reducing their fees by 30-40% in accepting $69 for a standard consultation, with fixed ongoing overheads that include 11.5% superannuation and more.
And yet, people are tempted, and I can see why.
It’s been a hard few years, especially for those of us who are consumers and self-employed/small business owners. We face rising costs of living in our personal lives coupled with rising costs at work: increased service fees, instability about patients booking when it costs more to see us, delaying appointments and trying to cram 30 minutes’ care into a 15-minute slot.
There will be some who are currently mixed billing who will crunch the numbers and decide to capitulate and return to UBB because it makes better financial sense or is easier.
There will be those who will give in to peer pressure since it appears that, in order to access the 12.5% PIP “bonus”, every single doctor in a practice will have to bulk bill every single patient every single appointment; in such a scenario the options for the rare doctor who wants to keep charging fees may be to give in to the majority or to leave for a different practice.
On the surface, the clear winners are:
- Those already UBBing especially in low SES areas and corporates;
- Those whose practice largely consists of quick and relatively straightforward consultations: scripts, medical certificates etc.
Who will it not benefit?
- Those now private billing who return to UBB. If you charge $90-108 or more for a standard consultation, you’ll now bill $63-69 in metro areas, effectively discounting every person by 30% or more. I assume service fees will remain the same as overhead costs will continue to rise year on year.
- If you’re a (female) GP who sees mostly longer consultations for mental health, women’s health and complex and chronic care needs, this will be worse for you even if you return to UBB because the rebate rise isn’t up to 62% but anywhere from 18% to 38% in metro areas. You’ll actually be worse off unless your gap was negligible to begin with.
As it stands, we’ve gradually seen erosion of item numbers that allow us to provide effective care for those with complex needs, and there is nothing to say this carrot doesn’t come with a different stick affecting more of these item numbers down the track.
All weekend, the forums have been abuzz with what this means, for us as GPs providing care, as well as in media about what this means for the average Australian.
For a population of 27 million $8.5 billion over four years is $80 per year per Australian.
The government has forecast a savings of $759 million per year on fees, which is ~$32 per year per person.
There is a sense of dejection among colleagues who’ve moved to gap fees and managed to find their feet while providing good care to their patients. This is the next round of obfuscation and election promises with no recognition of what it costs to provide quality care.
All the government seems to want is “free” at point of care, and it doesn’t seem to care much about the quality of the care as long as it’s “free”, provided by a GP or someone else pretending to be a GP.
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It’s also been promised to raise the number of GP trainees from the current 1500 to 3500, but it is unclear where these 2000 are coming from.
A colleague reported that last year was the first year that GP training managed to fill all 1500 positions, thanks in part to the financial incentives as well as practices moving away from UBB. Junior doctors want to become general practitioners but not if it means effectively working as charities, so how many will sign up for a form of indentured servitude to the government, in which they’re expected to behave as employees with none of the protections of employment?
It feels very much like an abusive spouse saying whatever he thinks it’ll take to lure you back to him for another try.
Yes, it’s an election year, and yet it also feels very much like it’s one more attempt to get us back to UBB instead of simply acknowledging that in 2025 the costs of providing quality care have risen in line with inflation.
Add to it an effectively frozen rebate since 2013 and it is not possible for most practices that aren’t high throughput to survive, much less thrive, on rebates that may finally be adjusted for inflation to $63-69, when the true cost of this service is now almost twice that.
General practice is a private business, not a charity. At this point it feels like navigating a daily minefield – new rules, new challenges, new hoops to jump through – and many will cave because in so many ways the promise of the old way is easier: simply bulk bill and stop talking about money.
The question you need to ask yourself, if you’re currently charging gap fees and are tempted to go back, is: “At what long-term cost am I going to capitulate?” The outcome will impact not only you, but also colleagues current and future contemplating general practice.
As with most choices, it’s never just about the choice we make today.
Dr Imaan Joshi is a Sydney GP; she tweets @imaanjoshi.
