What the latest data reveals about GP bulk-billing rates

If you’ve had trouble accessing a bulk-billing GP, you’re not alone.

Hundreds of GP clinics have started charging some, or all, patients for consultations in the past few years, leaving patients checking their bank balance before they book an appointment.

To try to address this, on the weekend the Albanese government pledged $8.5 billion to expand bulk-billing incentives for GPs.

They say it will mean 90 per cent of visits will be free by 2030. The Coalition quickly promised to match the funding.

Figures from the Australian Institute of Health and Welfare show about 77 per cent of GP visits are currently bulk-billed.

While that is a drop from 40-year high of 89 per cent in 2020 at the peak of COVID, it might seem surprisingly high if you’re one of the many people who struggle to find a bulk-billing GP.

And there’s a good reason for that.

Depending where you live and how old you are, the proportion of GPs willing to bulk-bill can be much, much lower.

Those figures also leave out some other ways you might find yourself out of pocket after seeing a GP.

Who is being bulk-billed?

Almost 90 per cent of GP visits for patients aged over 65 and under 16 are bulk-billed.

That’s driven by the current incentives on offer to GPs for bulk-billing kids and older people, compared to just 68 per cent of patients aged between 16 and 64.

The new incentives are designed to change that, by expanding the consultations eligible for them.

But slicing up the bulk-billing rate by the number of visits hides how rarely most people actually get bulk-billed.

That’s because children and old people — who are more likely to be bulk-billed — see GPs much more often, and so dominate the figures when broken down by number of visits.

Health department figures show in 2023-24, less than half of Australians were always bulk-billed when they saw a GP.

Where are you most likely to get a bulk-billed appointment?

Where you live also makes a huge difference, with the highest proportion of bulk-billing happening in regional and remote areas of Australia as well as in lower socio-economic areas.

So, if you’re aged between 16 and 64, seeing a GP in a metropolitan area — say North Sydney, for example — then just over 55 per cent of visits are likely bulk-billed.

But if you’re over 65, and in a regional area like Port Augusta in South Australia, then over 97 per cent of visits are bulk-billed, and that rises to more than 99 per cent for children.

People in lower socio-economic areas are also more likely to be bulk-billed and pay less when paying a fee to visit the doctor.

According to the most recent full-year data from 2023, the annual bulk-billing rate for the lowest socio-economic areas was 87 per cent compared with 68 per cent in the highest.

The difference in out-of-pocket costs when patients weren’t bulk-billed was stark, with those in the lowest socio-economic areas paying an average of $39 out of pocket compared with an average of $47 in the highest.

So if you’re not a kid or an old person, and you’re in a metro area — and a well-off one at that — you could find it very hard to see a GP without getting charged out of pocket.

But that’s not where the story ends.

Why does it feel like there’s not enough bulk-billing?

Medicare experts and consumer groups say there seems to be a difference between what the statistics show and the reality of bulk-billing on the ground.

According to medico-legal expert Margaret Faux, that’s partly because some doctors are charging co-payments without telling Medicare.

Dr Faux runs a business that offers medical billing software and services to doctors and said she often heard from GPs that they used this practice, some without realising it was against the law.

Since Medicare isn’t informed of the co-payments, Dr Faux said they’re not captured in the official figures.

“That’s where the bulk-billing statistics are way off.”

Another thing that could make the figures seem unrealistic is that while GPs might bulk-bill for a verbal consult, they could also charge out-of-pocket costs for procedures like skin cancer removals, ingrown toenail removals and IUD insertions at the same visit.

So while patients may be bulk-billed for the consultation and it’s counted in the bulk-billing statistics, they might still be out of pocket for the costs of any medical procedures, Dr Faux said.

Could 9/10 GP visits really be free?

Well, that all depends if doctors choose to take up the bulk-billing incentive.

The Royal Australian College of General Practitioners (RACGP) — which trains GPs and represents the profession — says Medicare rebates haven’t kept pace with the costs of providing care, especially in metropolitan areas, where rent and other costs are higher for GP practices.

The government incentives are skewed to provide higher rebates in regional and remote areas, meaning its likely more practices there will utilise them.

However, the rates of bulk-billing are already significantly higher in those locations.

RACGP president Michael Wright said it would take GPs time to determine whether it would be financially viable to move to bulk-billing.

Loading

He said doctors were also worried patients would expect all appointments to be bulk-billed under the changes, even when it wasn’t cost effective for practices to do so.

Clinics in metro areas, where there’s already lower bulk-billing rates, are the least likely to take it up.

“It doesn’t mean everyone is going to get bulk-billed because if the rebates are still too low to cover the costs they’re not going to be able to take part in the program,” Dr Wright said.

The funding announcement is welcome news to consumers struggling with rising healthcare costs but it’ll take time before patients see relief in their hip pocket.

The government said it wasn’t expecting 90 per cent of visits to be bulk billed until 2030 — and that’s optimistically assuming GPs, dealing with their own rising costs, fully get on board.

Loading…