Universal bulk-billing practices down by 50% in two years

We already knew bulk billing only clinics were going the way of the dodo. Now, we know exactly how endangered a species they are.

---

In February 2022, 60% of software vendor Cubiko’s GP clinic clients offered universal bulk billing. By December 2023, this proportion had dropped to around 25% as practices shifted to mixed billing.

The new data was drawn from 800 clinics across Australia that opted in to Cubiko’s data-sharing program, Touchstone.

It’s a slightly different methodology from the Cleanbill Blue report, which relies on surveying general practices directly.

Both reports came to the same conclusion: that only a quarter of GP clinics are universally bulk billing their patients.

That’s not to say there isn’t a silver lining.

The nosedive in bulk bill only clinics – which Cubiko defined as medical practices that bulk billed 80% of services or more – did plateau following the November 2023 introduction of tripled bulk-billing incentives.

November also saw the largest increase in billings per hour – 12% for bulk-billing clinics and 6% for mixed-billing practices – in a single month across the whole dataset.

It went some way toward closing the earning gap between mixed billing and universal bulk-billing clinics.

Before the tripled incentive payment, bulk bill only practices earned about $30 per hour less in billings than mixed-billing practices. Now, they only earn around $12 less.

Former RACGP Queensland chair Dr Bruce Willett was quoted in the report as saying that the tripled incentive had been a “desperately needed shot in the arm for practices” but was unlikely to reverse the long-term decline in bulk billing.

“GPs have felt betrayed by a succession of governments and will be reluctant to trust any government again and return to universal bulk billing,” Dr Willett said.

“The emphasis from GPs will be on affordability and equity rather than free healthcare services.”

Another key finding from the Cubiko report was that chronic disease management plans made up a higher percentage of total billings for rural clinics than for metro clinics.

Health assessments also made up around 25% more as a proportion of total billings for rural practices.

In short, the report concluded, country doctors are dealing with a higher complexity of care.

While rural clinics are more reliant on bulk billing – around 70% of services are bulk billed in the bush, compared to 60% in the city – rural GPs also see fewer patients per hour.

When they did bill privately, the rural clinics charged the same amount as a metro practice.

Despite these differences, both rural and metro clinics have similar average billings per hour.