When bulk billing fails, try bartering

Bypass Medicare altogether and exchange your knowledge of URTIs and eczema for something practical.

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A Sydney medical centre has given up on billing Medicare and charging gap fees and is using a bartering system to pay for appointments.

The Medical Republic spoke with Professor Candid who works at the Bulgakov Clinic in inner-outer Sydney.

“As you know, Medicare rebates were frozen a decade ago and while the current Labor government is happy to fund pharmacists to diagnose UTIs and pay nurse practitioners to treat complex patients, it continues to devalue general practice.”

The Bulgakov clinic was set up to serve a very socioeconomically deprived part of the city, where the median apartment price is barely $2 million.

“As you can imagine,” continued Professor Candid, “our patients weren’t too keen on paying a $40 gap fee. And so that’s when we hit on the idea of using a bartering system instead.”

Under the new system the patient receives medical care in exchange for goods. Professor Candid shared a typical list.

Condition	Bartering Fee
Eczema	2.5kg of turnips
Psoriasis	5kg of spuds
Anal fissure	Bag of door handles
B12 injection	2 metres of tartan fabric
Prolia injection	A roll of copper wiring
Methadone prescription	Laptop and 1 x mobile phone with cracked screen  (probably stolen)
Viral URTI	Victorian garden lamp post
SOBOE	The Da Vinci Code by Dan Brown
ACL rupture	Cordless hedge trimmer from Aldi
Low back pain	Box of buttons (non-matching)
Migraine	1 x Caprotti valve gear
Dry eye	Vintage black telephone
Type 2 diabetes	A brass rubbing from Salisbury Cathedral
Sub-fertility	Some thimbles
COPD	Pack of flavoursome menthol cigarettes

“The bartering system seems to be working really well,” Professor Candid told TMR.

“I feel like I’ve got my self-respect back. Only last week I treated a man’s piles and got 4m of lead piping, a month’s supply of dog food and some boiler lagging!”