News
Yearly bulk billing rates plummet
Practices are being forced to pass on their costs to patients, as owners worry about skyrocketing bills and the looming spectre of payroll tax.
A recent survey of more than 200 medical centres found more than half plan to reduce bulk-billing this year.
Annual bulk-billing rates have hit their lowest point in more than a decade, as cost-of-living pressures continue to push clinics to the brink.
Medicare Benefits Schedule findings have revealed national bulk-billing rates for GP services dropped to just 80.2% in the last financial year.
The numbers fell from a peak of 88.8% in 2020–21 to yearly rates not seen since 2010–11, according to the Department of Health and Aged Care.
However, there was a slight reprieve for patients over the last quarter of 2022–23, with rates rising slightly.
Over the year, bulk-billing rates for Level B consultations saw a 9% decrease, while Level C fell 8.6% and Level D dropped by 5%.
RACGP Expert Group – Funding and Health System Reform member Dr Cath Hester told newsGP practice costs have ‘accelerated enormously’ in recent months, making these latest results ‘unsurprising’.
‘Practices are having to make the difficult decision to reduce bulk-billing rates so that they can cover their expenses,’ she said.
‘Everything has increased in price – subscriptions, insurance, the consumables we use. I think I would really struggle to think of anything that hasn’t increased in price in the last 12 months.
‘We’ve had to drop bulk billing for healthcare cardholders in the last 12 months because we just couldn’t keep up with the increasing costs and margins.’
This year, bulk-billing rates were highest in New South Wales at 84.2%, while it was lowest in the Australian Capital Territory at just 56.6%.
The bulk-billing slump for patients comes in the midst of a cost-of-living crisis, with Productivity Commission data finding 3.5% of respondents who needed to see a GP in 2021–22 delayed their appointment, or skipped it completely, due to cost.
In Tasmania, that number rose to 7.6%.
According to the MBS, the average patient contribution in the past three months was $43.35, 41% more than in 2012–13.
At the same time, general practice service delivery has increased, with the 43 million consultations recorded across April, May and June this year, representing a 28% increase on 10 years ago.
Dr Hester said GPs do not want to be charging patients more, but many practices can no longer absorb the costs of bulk billing.
‘GPs are very mindful of the cost-of-living pressures for our patients, and it puts us in a really difficult position because we genuinely dislike having to bill patients for crucial medical care, especially when we know that they might be doing it tough financially,’ she said.
‘I think it affects GPs far more than other specialists because we’re so connected with our communities and our patients, so it becomes a little bit of a moral hazard for the GP in trying to decide who we bill.’
May’s Federal Budget included $3.5 billion over five years to triple the bulk billing incentive.
The changes also allowed for metropolitan children and concession card holders who are bulk billed by a GP to receive a $60.40 Medicare subsidy, compared to the standard $39.75 rebate.
While this was welcomed, and long advocated for by the RACGP, it was no silver bullet for struggling practices.
Doctors are now calling for an investment overhaul on a systemic level, with more funding funnelled into keeping costs down.
A recent survey of more than 200 practices across Australia found 55% plan to reduce bulk billing and increase gap fees in 2023, while more than one third had already cut back.
Of those same practices, 78% said they experienced higher costs in 2022 when compared to previous years.
Adding to those rising costs, is the looming threat of payroll tax changes.
Last week, the college again pleaded with governments to take urgent action and scrap the tax grab, which threatens to derail already struggling clinics.
‘In the back of our minds, we’re thinking we have to build up a bit of a war chest in preparation for when that actually hits,’ Dr Hester said.
‘I think we just have to harden ourselves to the fact that we need to continue charging an appropriate amount of money for the services we provide.
‘As a practice owner, I simply can’t continue to subsidise bulk billing for my small little business.’
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