Patient Perspectives: Rising Concerns Over GP Care Expenses

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Only 20% of new adult patients lacking a concession card are receiving bulk billing for every GP visit, as stated in a new report released by the online health directory Cleanbill.



Its findings, disclosed on Monday, indicated that New South Wales had the highest rate of universal bulk billing for those without concession cards at 34.5%, with Tasmania noted for the highest gap fees averaging $54.26 per standard MBS item 23 consultation.



Cleanbill suggested that the national rate of universal bulk billing for non-concession card holders declined from 35.1% in 2023 to 20.7% currently. The report also highlighted a 4.1% annual increase in gap fees across the nation, reaching an average of $43.38.



The Australian Capital Territory recorded the second highest average out-of-pocket expense at $51.84, followed by New South Wales at $44.05, and the Northern Territory at $43.86 – all exceeding the national average.



Victoria represented the second highest bulk billing rate for non-concession card holders at 19.1%, trailed by 13.9% in Queensland, and 9.5% in the Northern Territory.



According to Cleanbill’s Blue Report, these results are from a survey concerning pricing and the availability of 6,925 general practices conducted since October of the previous year.



It also noted an increase in the number of individuals forgoing GP appointments due to financial worries, referencing an analysis released by the Australian Bureau of Statistics (ABS).



In November of last year, the ABS unveiled its annual Patient Experience Survey, revealing that the proportion of individuals who abstained from visiting their GP due to financial reasons rose from 7% in 2022–23 to 8.8% in 2023–24.



The Cleanbill survey is part of a sequence of articles in Nine Newspapers which evaluated the growth in bulk-billed visits for children and concession cardholders while emphasizing the increasing financial pressures on working-age adult patients.



Although no specific details have been disclosed yet, the newspapers also indicated that expanding access to bulk billing is likely to be a significant pledge for the Labor Party in the forthcoming federal election.



RACGP President Dr. Michael Wright mentioned there is compelling evidence that such funding could enhance access to GP services and reduce out-of-pocket costs following decades of underfunding and a freeze on Medicare.



‘Government statistics and the RACGP’s Health of the Nation report have demonstrated that the tripling of incentives has allowed GPs to bulk bill more children and concession card holders, particularly in rural and remote areas where incentives are the most substantial,’ he stated.



‘However, the majority of Australians do not qualify for higher incentives and are missing out.



‘The RACGP has consistently advocated for an increase in patient rebates, especially for prolonged consultations, which more Australians require to cope with chronic and complex health conditions.



‘This will significantly benefit patients and communities nationwide. It will enhance the health and wellbeing of our population and alleviate the burden on our hospitals and the entire healthcare system.’



Nonetheless, Cleanbill’s methodology and conclusions have been rigorously questioned by the Department of Health and Aged Care (DoHAC) and Federal Health and Aged Care Minister Mark Butler.



Minister Butler communicated to the ABC that he was ‘cautious’ regarding the report, characterizing it as ‘essentially… a survey of general practices to inquire whether they bulk bill every individual that comes through their front door, be it Gina Rinehart or a pensioner’.



He further emphasized the influence of the tripled bulk billing incentive, effective for children and concession cardholders since November 2023.

Minister Butler mentioned that there has been an increase in bulk billing across all states and territories since its implementation, and that the overall number of GP visits rose by 1.2 percentage points in the past year.



‘Official records indicate that our significant investment in bolstering Medicare has interrupted the decline in bulk billing that occurred under the Liberal and Nationals Government,’ he informed newsGP.



The Minister’s office also stated that the Cleanbill report may not accurately reflect the experiences of all individual patients, referencing data suggesting adult patients lacking a concession card are still often bulk billed at mixed billing clinics.



While the RACGP welcomed the tripled bulk billing incentive at its announcement in May 2023 and acknowledged its subsequent effects, Dr. Wright contends that additional reforms are necessary to benefit a larger segment of the population.



‘Current rebates for patients do not approach the expense of care, forcing people to pay more out-of-pocket, making it challenging for GPs to bulk bill. Moreover, practices, like everyone else, have been impacted by inflation,’ he asserted.



In his reaction to the recent Cleanbill report, Minister Butler hinted at potential further investments in Medicare.



‘We understand there’s more to be done to continue strengthening Medicare after a decade of reductions and neglect from the Liberals, and we are dedicated to addressing it,’ he affirmed.

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bulk billing Cleanbill DoHAC Mark Butler Medicare