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Chapter 3: Funding Australian general practice care

3.2 General practice billing

3.2.1 Bulk billing

Almost nine in 10 (87.5%) of all general practice services were provided with no out-of-pocket cost to patients (ie were bulk billed) in 2019–20.1 The bulk-billing rate was higher for new telehealth items introduced in response to COVID-19 – 99.1% of telephone consultations and 97.5% of video consultations in general practices were bulk billed.1

While these figures provide an indication of total bulk-billed services in Australia over this period, they do not represent the number of patients who are bulk billed for all of their general practice care.

Patients may receive a number of services during a single visit to a GP, with some of these services bulk billed and others privately billed. Therefore, the proportion of patients bulk billed (and who therefore face no out-of-pocket costs for general practice care) is lower.

In 2018–19, while 86% of GP services were bulk billed, nationally only 66% of patients had all of their GP services bulk billed (Figure 35).

Figure 35. Bulk billing is not as common as Medicare statistics indicate

Bulk billing is not as common as Medicare statistics indicate

*2019–20 service data includes new telehealth items introduced March 2020
2019–20 patient data was not available at time of print
Measure: Percentage of bulk-billed services and bulk-billed patients in category ‘Broad type of services: Total non-referred attendances (excluding practice nurse items)’, Australia wide
Base: Population-level data
Data source: Department of Health. Documents prepared in response to correspondence from Senator O’Neill dated 4 October 2019 [Accessed 15 August 2020].
Data source: Department of Health. Annual Medicare statistics: Financial year 1984–85 to 2019–20. Canberra: DoH, 2020.

The proportion of patients who face no out‑of‑pocket costs varies between the states and territories. In 2018–19, the Northern Territory had the highest proportion of patients with all GP services bulk billed, at 76%. NSW was the next highest, at 72%. The ACT and Tasmania had the lowest proportions, at 39% and 49% respectively.48

The number of services and patients bulk billed has increased over time. However, each year the rate of increase slows further (Figure 36).

While nationally, the proportion of patients who have all their GP services bulk billed continues to increase, in several states the rate is in decline. The proportion of Tasmanian patients bulk billed for all GP services has steadily declined from 52% in 2014–15, to 49% in 2018–19. NSW and Queensland have seen slight decreases since 2017–18.48

Figure 36. Growth in national bulk-billing rates has been escalated by the pandemic

Growth in national bulk-billing rates continues to slow

*2019–20 patient data was not available at time of print
Measure: Growth in percentage of bulk-billed services in category ‘Broad type of services: Total non-referred attendances (Excl practice nurse items)’, Australia wide
Base: Population-level data
Data sources: Department of Health. Annual Medicare statistics – Financial year 1984–85 to 2018–19. Canberra: DoH, 2019.
Department of Health. Documents prepared in response to correspondence from Senator O’Neill dated 4 October 2019 [Accessed 15 August 2020].

Four in 10 GPs report that they bulk bill at least 75% of their patients.5 This number has fallen by 11% on the previous year.2 However, more than two in three GPs report they were bulk billing more patients as a result of the COVID-19 crisis (Figure 37).

When the COVID-19 MBS telehealth items were introduced in March 2020, it was compulsory for doctors to bulk bill all patients. GPs were required to continue bulk billing the majority of patients for several months after non-GP specialists and allied health professionals were permitted to bill privately.

The financial impact of this impost is further discussed in section 5.1.2.

Figure 37. GPs were bulk billing more patients as a result of the pandemic

GPs were billing more patients as a result of the pandemic

Measure: GP responses to the question ‘Have your bulk-billing practices changed compared to before the pandemic?’
Base: Responses to survey question, n = 1782
Source: EY Sweeney, RACGP GP Survey, May 2020.

3.2.2 Out-of-pocket costs

Patient out-of-pocket contributions continue to increase each year. The average patient co‑payment, or out-of-pocket cost, to visit a GP in 2019–20 was $39.33.1 In 2018–19, for the first time, the average patient out-of-pocket cost was higher than the Medicare rebate for the most commonly used general practice item (standard GP consultation less than 20 minutes – item 23). In 2019–20, this trend has continued, and the gap between the patient rebate for item 23 and the average out‑of-pocket cost has more than doubled from $0.26 to $0.58 (Figure 38).

Out-of-pocket costs vary across Australia, with patients in the Northern Territory and ACT experiencing higher out‑of‑pocket costs than in other jurisdictions. Remote and very remote areas also show higher patient out‑of‑pocket costs.1

Average out-of-pocket costs increased by 2.26% between 2018–19 and 2019–20,1 whereas the consumer price index (CPI) fell by 0.3% over the same period (Figure 39).


 

Figure 38. Growth in patient out-of-pocket costs are out-pacing the patient rebate

Growth in patient out-of-pocket costs are out-pacing the patient rebate

Measure: Value of MBS item 23 at July 2012 to 2020, and average patient contribution per service in category ‘Broad type of services: Total non-referred attendances (excluding practice nurse items)’, Australia wide, 2011–12 to 2019–20
Base: Population-level data
Source: Department of Health. Annual Medicare statistics: Financial year 1984–85 to 2019–20. Canberra: DoH, 2020.
 

Figure 39. Increases in patient out-of-pocket costs since 2013 are triple general inflation rates

Increases in patient out-of-pocket costs since 2013 are triple general inflation rates

Measure: Yearly increases in average patient contribution per service in category ‘Broad type of services: Total non-referred attendances (excluding practice nurse items)’, Australia wide, ABS all groups consumer price index in the 12 months to June quarter each year
Base: Population-level data
Data sources: Department of Health. Annual Medicare statistics: Financial year 1984–85 to 2019–20. Canberra: DoH, 2020.
Australian Bureau of Statistics 6401.0: Consumer price index. Canberra: ABS, 2020.

  • 1. Department of Health. Annual Medicare statistics: Financial year 1984–85 to 2019–20. Canberra: DoH, 2020.
  • 2. EY Sweeney. RACGP GP Survey, May 2019. Melbourne: EY Sweeney, 2019.
  • 5. EY Sweeney. RACGP GP Survey, May 2020. Melbourne: EY Sweeney, 2020.
  • 48. Department of Health. Documents prepared in response to correspondence from Senator O’Neill, 4 October 2019 [Accessed 15 August 2020].
  • 49. Wright M, Versteeg R, Hall J. General practice’s early response to the COVID-19 pandemic. Australian Health Review, 2020. doi: 10.1071/AH20157.

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