Skip to main content
Chapter 1: Patient interactions and health trends in general practice

Cost of care

The Australian Government contributes towards the cost of people seeing their GP through Medicare. Under Medicare, patient rebates are provided depending on the services people access from their GP.

Indexation of the patient Medicare rebates have not kept pace with inflation.

As shown in Figure 8, the rebate for a standard GP visit up to 20 minutes in 2023–24 was $41.40. However, if the rebate had increased with inflation since 2005–06, then the rebate would be $51.50.

This discrepancy means patients are paying a larger share of the true cost of their medical visits, putting a greater financial burden on households.

The growing gap between the Federal Government’s contribution to the cost of general practice care and the cost of providing care is affecting the sustainability of the primary care sector and the out-of-pocket cost for patients to access care. Health inflation for the 12 months up to May (6.1%) was notably higher than the overall Consumer Price Index Indicator, which measures inflation across the Australian economy (4.0%).7

Figure 8. MBS patient rebate for 20-minute consultation – actual increase versus indexation

MBS patient rebate for 20-minute consultation – actual increase versus indexation

Measure: Actual increase in MBS item 23 (standard GP consultation lasting up to 20 minutes) compared to the value had it increased in line with general inflation.
Source: Reserve Bank of Australia Inflation calculator, MBS Online.

Practising GPs report charging an average fee of $78.26 for a consultation up to 20 minutes, including the $41.40 rebate available in April/May 2024. This has increased from 2023 when the average fee for a consultation this length was $74.66. The proportion of GPs indicating they charge more than $85, including the current rebate, has remained relatively consistent with the results from 2023 (Figure 9). However, within this group there has been a notable increase (23% in 2023 to 37% in 2024) in the proportion of GPs charging over $90 on average for a consultation. 

Practising GPs report their fees are increasing in recent years.

Figure 9. Total fee charged by GPs for a 20-minute (Level B) consultation

Total fee charged by GPs for a 20-minute (Level B) consultation

Measure: Responses to the question, ‘What is the total fee for patients at your main practice for a standard MBS item 23 (Level B) consultation?’.
Sample: 2023 n=2050, 2024 n=3006
Source: The Navigators, RACGP Health of the Nation survey April/May 2024.

Over the past decade, out-of-pocket costs have risen across the health sector. However, out-of-pocket costs for GP services remain lower than non-GP specialists and allied health services delivered under Medicare (Figure 10). In 2023–24, the average out-of-pocket cost for a GP attendance was $45, compared to an average of $68 for allied health services and $117 for non-GP specialists.8

GPs continue to provide better value for money compared to other health and medical professionals. At present rates, seeing your GP is on average $23 cheaper than seeing an allied health professional and $72 cheaper than seeing a non-GP medical specialist even after the Medicare rebate.

Figure 10. Out-of-pocket costs for patients across the health system

Out-of-pocket costs for patients across the health system

Measure: Average patient contribution per service: Out of hospital patient billed
Source: Australian Government, Department of Health and Aged Care. Medicare annual statistics: State and territory (2009–10 to 2023–24). Canberra: Australian Government, 2024. Available at www.health.gov.au/resources/publications/medicare-annual-statistics-state-and-territory-2009-10-to-2023-24?language=en

Most GPs continue to offer fully subsidised or ‘bulk-billed’ care for most of their patients. This means patients do not pay any out-of-pocket costs for this care.

The proportion of GPs who bulk bill most of their patients has increased from 30% in 2023 up to 37% in 2024, while the proportion of GPs who bulk bill all their patients remains relatively steady at 13% (Figure 11). This has likely been influenced by the tripling of the bulk-billing incentives for care provided for Commonwealth concession card holders and children under 16 years of age in November 2023. However, the proportion of GPs fully bulk billing their patients remains low in comparison to 2022 (24%) as GPs face significant challenges with the rising cost of providing care and financial viability concerns (addressed further in Chapter 3).

Figure 11. GPs offering bulk-billed care to their patients

GPs offering bulk-billed care to their patients

Measure: Responses to the question, ‘What proportion of your patients are fully bulk billed for all of their care?’, by year.
Sample: Practising GPs 2020 n=1782, 2021 n=1386, 2022 n=3221, 2023 n=2050, 2024 n=3006
Source: The Navigators, RACGP Health of the Nation survey April/May 2024.

GP INSIGHT‘I have great concerns on the ongoing affordability of healthcare access due to financial constraints. I am a fully bulk billing GP registrar and find it guilty to move on to private billing, as when I grew up, seeing a GP was always an easily accessible occurrence without costs involved. The rising cost needed to access other healthcare needs such as patients needing to pay for specimen pots, or pregnant women now needing to fork out an extra $400+ for their pregnancy simply because the local radiology no longer bulk bills obstetric scans, the rising need for physiotherapy and psychology, but not being able to afford it is all so ridiculous. How am I meant to do preventative care and stop morbidity and progression for an osteoarthritic knee, if Medicare says you only need five physio OR exercise physiology sessions a year? How am I meant to stop my patient getting a heart attack due to obesity when the cheapest medication costs $150 out of pocket per month? How do I get my vulnerable, paycheck to paycheck self harming patient to pay the $90 gap for CBT? How could I ever find the conscience to ask them to pay to talk to me for 30 minutes for crisis counselling? No one is going to be able to afford healthcare at this rate!’

Bulk-billing rates remain higher in rural and remote areas, and areas of socioeconomic disadvantage (Figure 12). It is likely this has flow on impacts for financial viability of general practices in these areas, potentially compounding issues around access to care and workforce shortages.

Figure 12. Proportion of patients who are fully bulk billed by rurality (by Modified Monash region) and social disadvantage (by Index of Socioeconomic Disadvantage quintiles)

Proportion of patients who are fully bulk billed by rurality (by Modified Monash region) and social disadvantage (by Index of Socioeconomic Disadvantage quintiles)

Measure: Responses to the question, ‘What proportion of your patients are fully bulk billed for all their care?’ by MM region and Index of Relative Social Disadvantage (IRSD) quintile.
Sample: 2023 MM 1 n=1394, MM 2 n=197, MM 3&4 n=159, MM 5 n=236, MM 6&7 n=59, Quintile 5 n=541, Quintile 4 n=455, Quintile 3 n=426, Quintile 2 n=342, Quintile 1 n=271; 2024 MM 1 n=2092, MM 2 n=337, MM 3&4 n=176, MM 5 n=312, MM 6&7 n=87, Quintile 5 n=842, Quintile 4 n=664, Quintile 3 n=586, Quintile 2 n=541, Quintile 1 n=373.
Source: The Navigators, RACGP Health of the Nation survey April/May 2024.

The tripling of the bulk-billing incentives for Commonwealth concession card holders and children under 16 years of age, announced by the Federal Government in the 2023–24 Budget, has positively impacted the willingness of GPs to bulk bill more consultations. In metro locations, the incentive rose from $6.85 to $20.65 and in very remote locations it increased from $13.15 to $39.65. The incentive is scaled for those between metro and very remote locations using the Modified Monash Model.

One in four practising GPs say the proportion of consults they bulk bill has increased since the incentive payments for bulk billing were tripled.

This measure appears to have had the greatest impact in MM3–5, with 41% of practising GPs in these areas indicating they have increased the proportion of consultations that they bulk bill (Figure 13). GPs in training were more responsive to the change, with 31% indicating they had increased their bulk billing after the tripling of the incentives.

Figure 13. GPs reporting increased bulk billing following the introduction of tripled incentives

GPs reporting increased bulk billing following the introduction of tripled incentives

Measure: Responses to the question, ‘Since the introduction of increased bulk-billing incentive payments in November 2023, has the proportion of consults that you bulk bill increased, decreased or stayed the same?’.
Sample: MM1 n=2096, MM2 n=337, MM4 n=114, MM4 n=62, MM5 n=312, MM6&7 n=87
Source: The Navigators, RACGP Health of the Nation survey April/May 2024.

Bulk-billing rates vary by patient cohort, with veterans being the group most likely to be fully bulk billed (74% of GPs). A large majority of practising GPs (55%) also bulk bill all children under 16 and people in receipt of a government pension (52%). People with chronic disease will always be bulk billed by only 19% of GPs, but 53% of GPs will bulk bill more than 50% of the consults with this group.

Insights from the Cubiko Touchstone General Practice Industry Report

The Cubiko Touchstone General Practice Industry Report, published in early 2024, derives insights from their aggregated, de-identified benchmarking dataset. Drawing on data from 811 general practices across Australia, all of which have opted into Touchstone, the report provides an understanding of industry trends and supports informed decision-making within general practice.
 
Along with a decline in the total average bulk-billing rate, Touchstone data reflects a decline in the bulk-billing rate for patients under 16 years of age (a decrease from 91% to 79%) and concession card holders (a decrease from 90% to 84%) (Figure 14). The November 2023 introduction of the triple bulk-billing incentive stemmed this fall, as there was a marked increase in the total average bulk-billing rate, as well as in patients under 16 years of age and concession card holders, from November to December 2023. The biggest increase in bulk-billing rates was witnessed in concession card holders, as the rate increased from 78% in November 2023, to 84% in December 2023.9

Figure 14. Bulk-billing rate as a percentage of invoices across eligibility types

Bulk-billing rate as a percentage of invoices across eligibility types

Measure: Bulk-billing rate as a percentage of invoices across eligibility types
Sample: Based on de-identified data from 811 Australian general practices
Source: Cubiko, 2023 Touchstone General Practice Industry Report. Available at www.cubiko.com.au/resources/general-practice-benchmarks-2024

GP INSIGHT‘The biggest pressure at the moment is the inability for patients to afford medications, allied healthcare or mental health input. I think that governments also forget that patients from rural locations have the added cost and time pressure of being able to physically access appointments, even if they are available via Medicare and funded by the government. They do not have the transport or the means to fuel to travel to metropolitan areas to see the subspecialised teams that metropolitan patients have ready access to. My other concern is the ongoing lack of support for mental health and domestic violence in the community, with GPs unable to source ongoing support for these patients who are mentally and physically in danger. I have had numerous patients who have PTSD and developing anxiety disorders secondary to partner aggression and violence, and it is extremely difficult to access support when the offender is still in the community and there is limited resources for safe houses or police support in a rural area.’
Previous Next
© 2025 The Royal Australian College of General Practitioners (RACGP) ABN 34 000 223 807