Universal bulk billing takes another tumble

The Health Minister has hinted at Big Plans for bulk billing, but he may be a day late and a dollar short.

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The proportion of GP clinics offering bulk-billed appointments to every patient has dropped by another four percentage points in 12 months, according to patient directory CleanBill’s latest report.

It comes as Australians prepare for a federal election, with Health Minister Mark Butler rumoured to be planning on extending the GP bulk-billing incentive even farther.

According to the 2025 CleanBill Blue Report, released today, just one in five GP clinics across the country will agree to bulk bill new, adult patients for a standard consult, down from 24% in 2024 and 35% in 2023.

It’s a far cry from the Department of Health and Aged Care figures, which peg the national bulk-billing rate at 77.3%.

As opposed to the official MBS statistics, which measure bulk billing across all non-referred GP encounters, Cleanbill’s bulk-billing rate is only reflective of standard, business-hours Level B consults with an adult patient who is not eligible for any concessions at clinics which are currently accepting new patients.

“When you’re looking at the [Cleanbill] bulk-billing rate, you’re looking at the percentage of clinics [in an area] that are available to bulk bill … a regular adult for a standard consultation,” Cleanbill CEO James Gillespie told The Medical Republic.

The jurisdictions that saw the biggest declines in Cleanbill bulk-billing rates over the past 12 months were the Northern Territory, falling from 20% to 10%, and Victoria, where rates decreased from 25% to 19%.

Tasmania and the ACT have the lowest Cleanbill bulk-billing rates in absolute terms, at 0% and 3% respectively. 

The smallest two jurisdictions also led the pack in terms of out-of-pocket costs; Tasmanian GPs charged patients $54 out-of-pocket while Canberran GPs charged $52.

Australia-wide, the average GP now charges patients about $86 for a Level B, roughly half of which is covered by the patient’s Medicare rebate.

It’s an increase of just $2 on Cleanbill’s 2023 average, but represents a four percentage point rise over 12 months.

The previous year saw a larger decline in Cleanbill bulk-billing rates, but a slightly smaller increase in average out-of-pocket cost.

Mr Gillespie said the reversed trend may be because when a clinic switches to mixed billing it tends to set lower-than-average private fees at first.

“They’ll [tend to] add on an out-of-pocket fee, but it won’t be the average out-of-pocket fee,” he said.

“It’ll usually be a below-average out-of-pocket fee, and that often brings down the average out-of-pocket costs that you see for an area.”

With a smaller decrease in the Cleanbill bulk-billing rate in 2024 compared to 2023 – i.e. fewer clinics switching to mixed billing and bringing the average down – Mr Gillespie said he was not surprised to see more of a jump in cost.

Nationally, around 90% of GP clinics told Cleanbill they were accepting new patients.

“It is also a measurement of accessibility, the availability rate, because in order to get into a bulk-billing clinic to start off with, that clinic has to be able to take on new patients,” Mr Gillespie said.

“I think it also might be worth mentioning that, in the report, we quote a 0% bulk-billing rate in Tasmania.

“Now there may, in fact, be clinics that will bulk bill a regular adult in Tasmania, but they may just not be taking on new patients.”

Questioned earlier this month on whether Labor had a plan to address rising out-of-pocket healthcare costs, Mr Butler said he was committed to “doing more” to boost bulk billing and “keeping a very keen eye on what’s happening with patients who aren’t covered by the bulk-billing incentive”.

According to unnamed government sources who spoke to Nine Newspapers, Mr Butler is expected to announce a policy to “lift the bulk-billing incentive paid to GPs” and make moves away from fee-for-service ahead of this year’s federal election.

While he could neither confirm nor deny the former, Mr Butler said he did not foresee a situation in which there was no fee-for-service element to Medicare.

“What [GPs] do now is not deliver single episodes of service, but they are more and more involved in delivering wraparound care for people with complex chronic conditions,” he said.

“I’ve said for a couple of years now [that] our MyMedicare system is a pathway we want to travel down, and I think we have the support of the AMA and the [RACGP] to do that.

“But we’re going to do it in a steady way … that brings not just the medical community with us, but also patients.”

RACGP president Dr Michael Wright said he expected to see “bold commitments from all political parties” on health as election season ramps up.

“With proper investment in Medicare we can increase bulk billing, and reduce out-of-pocket costs, for people who aren’t being bulk billed,” he said.

“Both of these things are crucial.”