Tripled BBI unlikely to reduce out-of-pockets, say researchers

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A new analysis of Medicare data adds to the theory that bulk-billing incentives only benefit a relatively small proportion of the population.


New research published in the MJA this week has put paid to any remaining hope that the Commonwealth’s tripled bulk-billing incentive would help boost bulk billing – or at least reduce out-of-pocket costs.

Paper co-authors Dr Karinna Saxby and Professor Yuting Zhang, both University of Melbourne economists, analysed the proportions of bulk-billed GP services and average out-of-pocket costs by geographic region in 2022.

The tripled incentive payment was not introduced until late 2023.

While this measure was explicitly targeted toward concession card holders and children, there was a vague hope that the extra funding on these vulnerable patients would allow GPs to lower private fees across the board.

This was not borne out.

According to the new MJA article, this outcome was somewhat foreseeable given the fact that, except in rural areas, GPs only stood to gain an extra $20 from the bulk-billing incentive.

“We found that people pay a mean $43 in out-of-pocket costs for non bulk-billed general practitioner visits in Australia, more than the bonus for bulk billing,” the authors wrote.

“The current incentives are therefore unlikely to be sufficient for reducing out-of-pocket costs, particularly for people in metropolitan areas.”

Their analysis also found that rural areas trended toward higher out-of-pocket costs and that large differences between fees across regions could lead to unintended consequences.

“In areas where the bonuses are higher than local fees, they could drive up fees and even lead to higher out-of-pocket costs for people not covered by the incentive program,” the authors wrote.

“As an alternative, the government could reduce bonus payments to the local fee level in rural and remote areas and redistribute the money saved to ensure that people with lower incomes and children receive free general practitioner care, regardless of where they live.

“As financial incentives for specific patient groups (instead of regions) reduce differences in primary health care use, they could also be used to help other priority groups, including Indigenous people and people living with disability or long-term health conditions.”

With a federal election coming up, Health Minister Mark Butler has hinted that Medicare will be a major platform for Labor.

The election date has not been announced at time of writing.

Medical Journal of Australia 2025, online 27 January

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