Bulk-billing incentive not sensible for all GP clinics

Transcript: AMA Queensland President, Dr Nick Yim, 4BC Radio, Drive with Gary Hardgrave, Wednesday 23 July 2025

Subject: Bulk-billing

GARY HARDGRAVE: Apparently all you want is a Medicare card simply to enter your physician and say, that is it, ship the invoice to Albo. But 1 / 4 of GP clinics are unlikely to take up the federal authorities’s bulk-billing incentive, and I get it. Every GP clinic, each physician’s operation, is like several small enterprise. It’s acquired to pay the wages, it is acquired the insurance coverage, acquired to pay the electrical energy, it is acquired to pay the lease. All of these issues are going up, and albeit the Medicare levy would not lower it, would not compensate for the actual price. In February, within the election marketing campaign, the Labor Party introduced it might ship 18 million extra bulk-billing GP visits a 12 months by means of $8.5 billion in funding. And all through the Prime Minister promoted the coverage regularly saying all you want is a Medicare card, not your bank card. That’s simply baloney.

If you desire a good physician, I’m ready to pay the hole and I do. My physician used to bulk-bill, however the final couple of years, it is simply been economically not viable for my GP to bulk-bill everyone. They desire a contribution as a result of the price of operating a GP clinic simply retains rising. In The Australian newspaper article, they supplied the federal government questions whether or not Labor’s proposed 12.5% incentive break up between practices and suppliers gives incentive for medical doctors to hitch. I do not suppose it does. Modelling exhibits an estimated 25% of clinics will not be drawn into this system, so it is form of Russian roulette. I do not suppose it is the fault of the medical doctors. Dr Nick Yim is the President of the Australian Medical Association Queensland. He joins me now. I need to again you and your members, physician. Have I acquired any of this incorrect? Because I do not know the way medical doctors afford to maintain a few of their doorways open.

DR NICK YIM: Good night, Gary. You’ve produced a extremely good abstract there. This is one thing we highlighted through the election marketing campaign the place the federal government promoted 9 out of 10 consultations can be bulk-billed. We have been sceptical as a result of after we surveyed a number of normal practices across the state of Queensland they mentioned it isn’t attainable to bulk-bill everybody, even with this extra rebate. Looking on the analysis and the media coming that is popping out, that most likely highlights our trigger. 

GARY HARDGRAVE: I get it. Every apply – medical doctors, normal practitioners – when you’ve acquired a very good one, lots of people discover out about it. They beat a path to their door they usually want extra employees, they want greater apply surgical procedures. The price of renting areas, air con, insurance coverage, every thing that goes with it – it is a fairly hefty little bit of coin earlier than anyone within the physician’s household will get any cash out of the method. 

DR NICK YIM: The key factor right here is the affected person’s Medicare rebate, our Medicare rebate, simply actually hasn’t stored up with the occasions. And it isn’t that the fault of the present authorities. Obviously, it is a number of years of neglect of our healthcare system that has led us to this place. Currently, our inhabitants is getting older. It’s changing into extra complicated, extra illnesses. What we do must see is the funding of complicated care, longitudinal care and funding these groups which can be current within the normal apply: the nurses, the allied well being employees, the train physiologists, physios, and many others. 

GARY HARDGRAVE: Because the clinics do deliver a number of totally different companies in. They all price cash. And the controversy years in the past when Medicare first began, and I’m an amazing supporter of Medicare, was that there needs to be a possibility to say, when you have been capable of, insure for the hole. The distinction between what the rebate paid and what the actual price of delivering that healthcare was, you may insure in opposition to, however they will not allow you to do this. 

DR NICK YIM: Definitely. As a GP myself, I’d like to bulk-bill all my sufferers, from the younger to the aged. I’d love to do this. But on the similar time, what is the good of a GP apply if we can’t maintain our doorways open? As you alluded to, we have bills as nicely. We know not too long ago that superannuation has elevated by 0.5%. Wages are going up, insurances, lease and electrical energy as nicely, so it is that positive juggling act. Not every single apply is similar. A apply in Brisbane will likely be totally different to, say, a apply in Mount Isa, and they’ll have additionally totally different bills and totally different fashions of care. 

GARY HARDGRAVE: When I used to be in federal parliament 1 / 4 of a century in the past, there was increased bulk-billing charges led to by one factor, and that was a optimistic initiative. But this is sort of a quarter century in the past. There was an effort to really improve bulk-billing charges. There’s nothing new with this. It’s fallen again in recent times. It actually has. Now they need to attempt to deliver it on once more, throwing extra money on the drawback. That’s comprehensible. But the issue nonetheless stays that some individuals perhaps, oversubscribe, overuse, when you get what I imply, the go to to the physician, whereas those that desperately must go to the physician keep away from it as a result of they’re afraid of the prices. To the Prime Minister’s level, it should not be about your bank card that dictates having access to well being companies. But the entire thing is simply out of whack. We want good medical doctors to be paid good cash to do the nice work they need to be capable of do. We should be incentivising that longitudinal, long-term continual care so sufferers and people might be forming that relationship with their normal practitioner and that apply as nicely to ship that care. 

The key factor right here is that we do want a measure of applicable indexation 12 months on, 12 months out so we’re not going to have these discussions each single 12 months as a result of we all know inflation exists. We know that price 5 years down the monitor goes to be nice once more, so we do want measures in place. Federal Health Minister Mark Butler was on 4BC Breakfast this morning. Here’s what he needed to say: 

PETER FEGAN: Let’s say a household walks right into a GP they usually see bulk-billing on the large signal, you recognize, all of us stroll in, bulk-bill, proper? Goes into the physician says, you recognize, for my part, I do not need to bulk-bill. I feel I’m going to cost you a spot or I’m not going to bulk-bill you. What occurs then? 

MARK BUTLER: Well, they do not get the cash from the federal government. And that is the purpose. I’ve seen the AMAs within the paper this morning saying what they need is for us to present over the cash – taxpayers’ cash – to medical doctors with no strings connected. And the medical doctors’ teams, you recognize, of their defence, they have been frank about this from the get-go. They wished us to fund them extra however not have a dedication to bulk-billing or a situation of bulk-billing tied to that. And I mentioned to them, I’m not going to do this. Particularly as a Labor Health Minister, I need to see outcomes for sufferers on bulk-billing.  There’s been a disagreement between us and medical doctors’ teams about this. But the three-quarters determine of practices relies on the actual fact our division has excellent details about what each GP is incomes by means of Medicare. 

PETER FEGAN: But they are a enterprise. They’re allowed to earn, aren’t they? 

MARK BUTLER: Exactly. I’ve by no means contested that, however we all know precisely what they’re incomes. And we’ve mentioned that if we raise the rebate for bulk-bill consults and pay them an extra incentive on prime, they are going to be financially higher off. 

GARY HARDGRAVE: Nick Yim, what’s your response to that? Because I do not know the place a few of these individuals are coming from, however they’re saying issues like there’s loads of Porsches out the entrance of most physician’s surgical procedures. I imply, that form of generalisation, that medical doctors is usually a physician, they’ll get entry to authorities help – however they cannot earn an excessive amount of. Capping the amount of cash medical doctors earn would not make any sense to me. 

DR NICK YIM: One of the important thing issues right here is we all know that every normal apply can have totally different fashions of care. Some practices may need a single GP and have an enormous quantity of nursing or administration employees. We additionally know {that a} normal apply in Brisbane may need totally different ranges of lease and bills versus a apply in a regional city. There are so many variabilities. If they’ve a blanket measure throughout the entire nation, for instance, it simply will not work out. And that is a few of the issues the place we have to guarantee there’s enough funding to advertise the take care of lengthy consultations and sophisticated care that we need to spotlight, not these shorter consultations. 

GARY HARDGRAVE: Maybe I’m spoilt, Nick. My GP, I will not title him, however my GP is a man who’s so and anxious in his sufferers and he has mentioned to me on quite a lot of events that for the quantity of expertise he is acquired, the variety of years he is been doing it, the caseload he has to work by means of, the accountability he has – he is not being profitable. Some medical doctors are doing it very, very robust. I do not know why authorities thinks that they’ll open up everyone’s checking account and determine how a lot cash medical doctors are supposed to earn. I actually do not get that. 

DR NICK YIM: I feel the important thing situation right here is, as I alluded to earlier, as a GP I’d like to bulk-bill each single certainly one of my sufferers. At the identical time, I additionally acknowledge there may be employees to be paid, the nursing staff, the administration staff, and there is a number of issues at play right here. This is one thing we do must work with the federal government on as a result of the federal government is correct – each Australian deserves entry to reasonably priced healthcare in a well timed vogue. 

GARY HARDGRAVE: Good to speak to you. Thanks for every thing. Dr Nick Yim, he is the AMA Queensland President.

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