Universal bulk billing practices are going extinct

The number of practices that bulk bill all adults for a standard consult has declined in 87% of electorates this year, Cleanbill reports.

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The number of practices that bulk bill everyone for everything declined in nine out of 10 federal electorates over the course of 2023, leaving nine electorates with none, according to data from a new Cleanbill report. 

But AMA President Professor Steve Robson warned that Cleanbill’s data doesn’t provide the full picture. 

“As Mark Butler explained last month, the Cleanbill report measures how many practices fully bulk bill every single patient that comes through their door for every single service,” Professor Robson told The Medical Republic. 

“This obviously does not provide the full picture of bulk billing rates in Australia.” 

Cleanbill’s report, published yesterday, analysed data originally published in the company’s Blue Report in January. 

This report analysed bulk billing and out-of-pocket costs for adults, without concessions, who are visiting a GP for a standard consultation (item 23) across Australia’s 151 Commonwealth electorates. 

“This report is absolutely groundbreaking and shows the true extent of the decline of accessibility of primary care across Australia,” said Cleanbill CEO James Gillespie. 

According to Cleanbill, this report is “the first to offer an electorate-by-electorate breakdown of changes in the bulk billing rate and average out-of-pocket cost of a standard GP consultation over the course of 2023”. 

And the results are “deeply concerning”, according to the group. 

Of the 87% of electorates that experienced a drop in practices that bulk bill all patients during 2023, some, such as Burt and Cook, saw a “staggering collapse in bulk billing” with an almost 50-percentage-point drop. 

Almost 16% of electorates have one or fewer dedicated bulk billing clinics as of the end of 2023. 

The number of electorates with no practices that bulk bill all adults for a standard consult increased from four to nine over the year. 

A recent Guardian analysis of practices listed as “bulk billing only” on a government health services register similarly found a loss of 400 dedicated bulk billing clinics and a 30% decline in bulk-billing only clinic in some electorates. 

“The story is much the same with out-of-pocket costs: some electorates saw decreases, but the vast majority of electorates showed increases in out-of-pocket costs, some by as much as 15% of the average fee at the start of 2023,” noted the Cleanbill report. 

The average out-of-pocket cost for a standard consult across all electorates rose by just under $2 to $41.42 in 2023-24. 

The largest increases were seen in Groom in Qld (over $6), and Clark in Tasmania ($5.90). 

Cleanbill reiterated that, given the decline in dedicated bulk billing practices and varying out-of-pocket costs “it’s critically important that Australians have easy access to availability and pricing information for every clinic around them”, as barriers to this information mean that many patients may end up in public hospitals. 

According to Professor Robson, the government is already making progress in stalling the decline of bulk billing. 

“The federal government’s significant down payment of around $6 billion for primary care in last year’s budget is already showing signs of promise, with statistics released at the start of this month showing the decline of bulk billing rates in general practice has been arrested,” he said. 

Speaking to TMR, RACGP President Dr Nicole Higgins concurred that “funding gets results”. 

“When looking at bulk billing as the overall proportion of consultations that are bulk billed following the tripling of the bulk billing rebate, government data has shown a 2.1% increase in bulk billing,” she added. 

And while “there’s still a long way to go to repair the decades of cuts and neglect to Medicare”, Dr Higgins was hopeful that the 2023 budget is “a first step” towards “rebuilding general practice”.  

Some electorates were able to maintain high levels of practices that bulk billing for all standard consults. 

Interestingly, all nine electorates where over 75% of practices bulk bill all standard consults were in Western Sydney. 

But Dr Higgins warned that this “doesn’t mean practices aren’t under financial stress”. 

“The drops in bulk billing-only practices elsewhere are a warning that without sufficient funding, practices do have to consider what is necessary to keep their doors open,” she said. 

“Payroll tax is also a big concern in states which don’t have a clear solution in place, including New South Wales and Victoria.  

“A failure to resolve that in New South Wales would make it significantly harder to remain a bulk billing-only practice.”