11 August 2022

RACGP: Free falling bulk-billing rates a sign of things to come

The Royal Australian College of General Practitioners (RACGP) has warned that general practice care needs a much-needed shot in the arm.

It follows reports of an increasing number of GPs ditching bulk billing, with a key underlying factor being inadequate Medicare rebates for patient consultations. A HealthEd survey of almost 500 GPs found 22% had recently changed their billing model, meaning patients are facing higher out-of-pocket costs to see a GP. One-third of those who changed their billing model moved from bulk billing to mixed billing (a combination of bulk billing and private billing), and 67% changed from mixed billing to completely private billing.

Rising practice costs and Medicare cuts were listed as key reasons for the billing changes. When asked the same survey question last year just 10% said they had recently changed their billing model.

RACGP President Adj. Professor Karen Price said that the figures were heading in the wrong direction.

“General practice is up against it, and unless government boosts investment in GP care, more and more practices will be forced to pass the cost on to patients,” she said.

“That is not a decision taken lightly and no one relishes the thought of asking their patients to pay more, particularly those struggling to make ends meet at a time of increased grocery and fuel costs just to name a few. But practices have no other choice because their own costs are rising, and Medicare rebates simply haven’t kept pace with the cost of providing high-quality care. Our hands are tied, we need help desperately.

“The Minister for Health and Aged Care Mark Butler has warned that primary care is in its worst shape since Medicare began and it’s hard to disagree. Many people are unable to find a bulk billing doctor despite the previous Government pointing to statistics indicating that the bulk billing rate was at a ‘record high’ of more than 88%. There is a simple reason for that – the devil is in the detail.

“There is a difference between the proportion of GP services that are bulk billed and the proportion of patients who had all their GP consults bulk billed. So, whilst it may be reasonable to say that bulk billing was sitting at more than 88% at the end of last year, if you dig in to the data properly you realise that the proportion of patients who had all GP care bulk billed was just 67.6% nationally in 2020 and 2021 and much lower in some states and territories. This is because there are some patients with multiple, complex issues who see their GP again and again for different types of conditions and this inflates the proportion of GP services that are bulk billed.

“Keep in mind some of the changes made to general practice billing during the pandemic too. Practices are still delivering many COVID-19 vaccinations, and it is mandatory for these be bulk billed. On top of that, certain patient groups, including children and concession card holders, were bulk billed for every single telehealth consult for much of 2020. So, in reality the bulk billing rate is not what it seems.”

The RACGP President said that investment in general practice was sorely needed.

“General practice care must be put on a more sustainable, long-term financial footing,” she said.

“Medicare patient rebates for GP consultations simply haven’t kept pace with the cost of providing high-quality care and on top of that the impact of the Medicare rebate freeze stretching all the way from 2013 to 2019 is still being keenly felt by GPs and general practice teams across Australia. Patient rebates did receive a small boost earlier this year, but only by 1.6% - which equates to just 65 cents for a standard GP consult.

“The federal Government could ease the pressure on practices and ensure no patients are left behind by boosting investment in general practice care. We are calling for a 10% increase to Medicare rebates for consultations lasting 20 to 40 minutes and 40 minutes plus as well as a new Medicare item for consults lasting more than hour. This will have a lasting impact on the health and wellbeing of people who need to have multiple health conditions carefully managed and result in fewer patients ending up in a hospital bed with a problem that could and should have been managed by their GP.

“The choice is clear, general practice needs a helping hand or else patients across Australia will be left behind.”

The RACGP’s comprehensive list of advocacy priorities can be found here.

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