Assignment of Benefit was a poorly conceived idea that could never work in practice. So why can’t we now scrap it and move on?

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Here is the question about the Assignment of Benefit (AoB) saga that isn’t about “will the software cope”, “is all that extra red tape going to be OK” or “is it really about putting the right legal framework in place to help avoid fraud”.

Why did the federal government ever think it was worth doing, given how complex and clearly unworkable the idea should have looked from day one (two years ago), with even a modicum of scenario modelling?

Which leads to a better question: why haven’t we scrapped it and moved on? Having something we know will still never work hanging over everyone’s head is maybe OK, until the year is up and you have to revisit the whole dumb tortuous idea.

The official story is that AoB, the formal consent a patient gives a GP to accept the Medicare rebate directly rather than paying up front and claiming it back, has technically always been a legal requirement.

From 1 July 2026, new rules under amendments to the Health Insurance Act 1973 were meant to force real, auditable consent, captured per service, retained for two years, with practices being told they faced genuine fraud exposure if they got it wrong.

After a wave of pressure from the AMA and the RACGP, the Department of Health, Disability and Ageing (DoHDA) backed down: verbal consent would remain acceptable in all settings for another 12 months, pushing the real deadline to 30 June 2027.

None of that explains why the rule ever needed to be so complex. A signed form saying “I assign my benefit to my doctor” would have taken a paragraph of legislation.

But what actually got built is a regime that, depending on which practice management vendor you ask, requires per-service capture, mandatory file notes, item-number-level scope tracking, 24-hour written notification obligations for certain patients, and two-to-seven-year record retention, with the legal risk sitting on the practice rather than the treating doctor.

That is not a consent form. It’s a new compliance infrastructure, bolted onto general practice with apparently no forethought, and by the government’s own admission, virtually no meaningful consultation and buy-in process beforehand.

Hint: enduring AoB was fast tracked

Buried in the same 18 June announcement that deferred almost everything else is the one part of the reform the government chose to accelerate rather than delay: enduring Assignment of Benefit.

This single set-and-forget consent component covering ongoing bulk-billed care, was originally scheduled for April 2027, was brought forward to 1 July 2026 at the last minute, but only for three groups: patients registered with MyMedicare, aged care residents, and patients of Aboriginal Community Controlled Health Organisations.

Everyone else, meaning the large majority of bulk-billed patients who haven’t registered with MyMedicare, was to be stuck with the harder, more expensive, error-prone version of the new regime indefinitely.

So, the easy path only existed for patients tied to MyMedicare.

Practices wanting to escape the compliance burden they might otherwise face were presented with a stark choice: get your patients to register or suffer the consequences.

In other words, among many other strange things we may never understand, AoB was very clearly about being a stick to try to kick start (again) MyMedicare.

The conspiracy theory doing the rounds is that AoB was never really about consent at all. After all, although the legal issue exists, it’s never been a problem ever.

But whether it’s a crazy conspiracy or not the practical effect is identical: bulk billing will get a lot harder to run unless the patient in front of you is enrolled in the one national platform the government has been struggling for two years to get any traction on.

Why MyMedicare now needs a stick

MyMedicare’s pitch isn’t bad: it’s a path to continuity of care and from that a means of transitioning an increasingly antiquated, top-heavy, fee-for-service model of paying GPs.

So formalise the relationship between a patient and their regular GP, and better outcomes should follow.

Registration is the plumbing the government thinks it needs in place before it can move general practice funding away from pure fee-for-service and toward something closer to blended or capitation-style funding to bring value based outcomes into the mix.

Medicare as it stands isn’t a good way to pay for keeping someone well over years.

The government thinks this comes down to there being no formal record of whose patient they are.

Chronic disease management items are already being linked to registration. It’s the promise of further “blended” funding sitting outside standard Medicare billing for complex and aged-care patients.

The problem is that nobody is signing up.

Depending on whose numbers you use, somewhere between one in 10 and one in five Australians are currently registered.

The Consumers’ Health Forum’s 2025 national sentiment survey found only a third of Medicare cardholders had even heard of the scheme, and of those, just over half had registered, an effective uptake rate well under 20 per cent of the population.

Practice-level experience reported by accountants working across dozens of clinics puts registration closer to 10 per cent of an active patient book.

Either way, two and a half years after launch, MyMedicare has a My Health Record problem: a good idea that the public simply isn’t opting into voluntarily.

Full disclosure: I’m still not registered, either. Who cares, right?

Here’s the nub of the problem the government has: I’m pretty lazy and pretty busy. I’ve got no incentive at all to go to the trouble of doing either. What’s in it for me to change my lazy ways?

What’s in it for most patients?

MyMedicare is a good idea, but not well thought out for some vital pieces of the funding puzzle.

Why not just do the My Health Record thing: “opt out”?

There’s a few reasons the government hasn’t simply legislated compulsory registration, or more likely “opt out”, like they did for the My Health Record.

The first I’m not sure the government has even contemplated so far, but they should: even with “opt out” the My Health Record didn’t actually engage patients much more. You need real and useful day-to-day utility – like a banking app. Something you can’t afford to be without.

The second reason would have been contemplated almost certainly by the bureaucrats.

The Constitution’s civil conscription provision, tested repeatedly since the 1940s in cases about Medicare and its predecessor Medibank, prevents the Commonwealth from compelling doctors into a particular occupation or forcing them to provide particular services.

It does not, on the High Court’s consistent reading, stop the government from using economic pressure, structuring incentives so that not doing the thing it wants becomes progressively more expensive or administratively painful.

That distinction between illegal compulsion and legal financial inducement is how bulk billing incentives, the Bulk Billing Practice Incentive Program’s loading, and now the AoB carve-out for MyMedicare-registered patients have all been built.

None of it forces anyone to do anything. All of it makes the alternative steadily less attractive.

Seen this way, AoB is not a rogue policy accident.

It’s the same lever the government has pulled before, pulled harder.

The trouble is that this particular lever turned out to be wildly disproportionate to the problem it was solving, and the collateral damage looks likely to land on exactly the thing the government is trying to protect – GP sanity and practice viability.

Why this particular stick backfired

The compliance cost of the reform, even in its softened, deferred form, is not trivial.

Some practice management vendors reportedly spent up to seven figures building AoB workflows into their software, a cost that gets amortised across the industry into the tens of millions once every clinic, terminal provider and payment processor is counted.

According to practice advisory principal David Dahm, independent modelling of the exposure for a mid-sized ten-doctor bulk-billing clinic puts annual Medicare clawback exposure, in the event of an adverse audit finding, at several million dollars, on top of civil penalties that can reach $220,000 per instance for a body corporate.

Dahm has been called Chicken Little a lot in his career. But this little chicken picked the payroll tax problem way before anyone else did. And he’s been doing the numbers and all the legal research on AoB, fortunately perhaps for GPs, unfortunately maybe for the government.

“Because the standard practice service agreement typically makes the practice, not the individual doctor, contractually responsible for billing, collection and reconciliation, that exposure sits with the business entity,” Dahm told The Medical Republic.

“A single patient complaint can be enough to trigger a full two-year workflow audit rather than a review of just the one consultation,” he said (cluck cluck).

Run the arithmetic on this – Dahm has – and the uncomfortable truth is that near-perfect compliance still isn’t good enough.

Says Dahm: “a clinic capturing consent correctly 99.9% of the time, genuinely excellent by any real-world standard, will still generate dozens of defective consents a year at typical consultation volumes, any one of which is a live audit risk.

“This is not a workflow problem software can fully solve. It’s a structural one”.

Faced with that asymmetry, between grinding administrative cost and existential downside risk on one hand, and the marginal convenience of accepting a Medicare rebate on the other, the entirely rational response for a practice is to stop bulk billing altogether and move to private billing with a transparent gap, leaving the patient to claim their own rebate.

That is the opposite of what all the current federal reform is meant to achieve: a policy built to nudge more people into MyMedicare so bulk billing could be preserved and better funded.

Instead it would push practices out of bulk billing entirely, taking their most price-sensitive, chronic and elderly patients with them.

We may have delayed the train. But it’s not even on the rails at the station waiting to come for practices next year.

What should happen now

A deferral fixes none of the existing issues and it doesn’t take a genius to model what is on the table to understand it’s just not going to work no matter how high you can get your compliance needle. Even a tiny failure can be catastrophic and trying to set up to achieve that level of compliance is financially crushing for practices.

AoB as a MyMedicare-conscription mechanism should be shelved permanently then.

Whatever the government’s actual underlying goal, and continuity of care and better population health data are genuinely worthwhile goals, this particular mechanism carries a real risk of collapsing the exact billing model it is meant to protect.

The 12-month reprieve should be used to formally abandon this approach, not to fine-tune it.

The govt needs to target us patients with something truly cool

All of this of course doesn’t mean giving up on MyMedicare.

It means going back to the drawing board that is legally uncontroversial and thinking this out a bit better.

It probably doesn’t mean just better-targeted incentives layered onto Practice Incentive Payments, deeper linkage of chronic and complex care funding to registration, and a gradual, New Zealand-style widening of the gap between what a registered patient and an unregistered patient can access.

Although none of that requires a single enforcement action against a single GP and it might slowly work, it has a big problem: the “slowly” bit.

Think patient. Think utility. Think why we all need a banking app and what the government might do to make a curmudgeon like me to actually register with my local practice.

I can think of a few things off the bat. Not entirely easy things mind you, but ones I’d definitely go for.

For example: if someone offered me an actual working all-in-one MyMedicare app that did all or most of the following, I’m pretty sure I’d be enthused enough to sign up:

• The basics of course: my Medicare no, my IHI, my listed practices (which it’d have because I signed up) and some Medicare direct messaging
• A booking engine just like Hotdoc and HealthEngine (the government could probably just contract them as a part of the app functionality) that talked to all my healthcare providers and quick access to ones I don’t use but probably could, like allied providers and specialists
• A simple to understand and up to date patient summary from my current GP practice – does not have to come off the My Health Record, but it does have to include all my current medications.
• Electronic prescribing functionality so I never see paper again, and potentially never actually have to visit a chemist – so delivery and local chemist connectivity – but a record of where all my prescriptions are at, when I need repeats, a repeats online functionality and so on
•  OK I give in. My My Health Record – easy to look at, much easier to navigate and understand than it currently is.
• If not above, all my pathology and imaging results in real time from whoever I get them from.
• An AI scribe I can take to all my healthcare appointments, that talks to my favourite AI if I want it to, seamlessly, and can generate a patient summary from a GP consult should I want. I’d set all this to automatic.
• HealthDirect direct … inside the app
• Ability to link in all the non medicare providers: so Eucalyptus for my Ozempic, and InstantScripts for my one-off antibiotics, and so on
• All my billing, if possible linked to my banking, so I can see all my government rebates or bulk billing, and any mixed billing I’m charged
• A real specialist gap fee directory – one that is comprehensive and works

OK, I think everyone gets the picture. I’ve probably missed some obvious other things.

But if someone offered me even half of this stuff on my iPhone, I’d pay for it.

The government has to start thinking in these terms about how patients see their health if they want actual engagement.

For actual engagement you have to offer actual value: all carrots mainly.

See ChatGPT and Claude for enrolment tips. Most of the patient population who sees a doctor is signed up to these organisations, and they are decidedly a dodgy group of companies with decidedly bad intent in terms of any of our wellbeing.

But we sign up right?

The invisible new funding money: salaried GPs

If we step back from AoB specifically, and broaden our vision, there is a bigger structural shift going on that has nothing to do with whether MyMedicare succeeds or fails.

And it’s happening largely without anyone voting on it or measuring it properly.

Australia is quietly splitting general practice access into three distinct lanes.

There is private billing, where the doctor sets the fee and the patient wears some or all of the gap.

There is the hospital emergency department, tertiary and genuinely acute.

And in between, growing fast, sits an entirely new bulk-billed, walk-in, no-appointment lane: Medicare Urgent Care Clinics.

There are now 137 of them operating nationally, all opened since the first one in June 2023, backed by $1.4 billion in initial funding and a further $1.8 billion committed in the most recent budget, with ongoing funding locked in from 2030-31.

More than 3.1 million visits have been made to them so far, and four in five Australians now live within a 20-minute drive of one.

UCCs are, structurally, salaried general practice. The doctors working in them are not billing per consult and taking home a percentage; they’re staffed on a sessional or salaried basis, which is part of why anecdotal reports of UCC wait times and consultation pace look nothing like a standard bulk-billing clinic under pressure to turn patients over quickly.

It’s a genuinely different economic model wearing the same GP badge, and it has gone from zero to covering most of the country’s population in under three years.

It isn’t the only place salaried and quasi-salaried general practice is quietly expanding, either.

Large insurers have been buying up GP practice groups outright. Corporate consolidation of general practice, something warned about in Australian medical press as far back as the late 1990s, has continued largely uncommented on.

And a genuinely new category, direct-to-consumer telehealth platforms such as Eucalyptus, InstantScripts and Mosh, has grown from a standing start into a sector valued in the hundreds of millions of dollars, some of it explicitly built on employing doctors rather than engaging them as billing contractors.

Nobody so far has published a clean, trustworthy time series tracking what share of Australia’s GP workforce is now salaried or quasi-salaried, corporate-employed or platform-employed, versus the traditional independent-contractor-on-a-service-agreement model that has defined general practice for decades.

Every workforce data source still describes contracting as the default. That absence of data is itself telling.

A structural shift this size, growing from zero urgent care clinics and a handful of telehealth start-ups five years ago to 137 clinics covering most of the population and telehealth platforms worth hundreds of millions today, is happening beneath the surface of the funding debate everybody is actually having in public.

AoB and MyMedicare are only the visible, contested front door.

Salaried care via UCCs, corporates and platforms is the back door that’s been quietly opening the whole time, with nowhere near the same scrutiny.

The comparison everyone reaches for

It’s tempting to point at the NHS here and say this is where Australia is headed, and general practice advocacy groups clearly fear exactly that.

But the comparison needs a caveat most people skip: most NHS GPs are not salaried government employees; the majority still work as partners in independent practices that hold a capitation-based contract with NHS England, paid largely according to the number and complexity of patients on their list rather than a straight wage.

Only a minority of NHS GPs are directly salaried. The genuine parallel to Australia’s situation isn’t “government-employed doctors,” it’s the loss of the direct, transactional certainty that fee-for-service gives a GP: under capitation, income depends on list size and formula, not on what you actually did that day, and that disconnect is a big part of why NHS general practice has struggled with burnout, list-size gaming and long waits.

That’s the fear driving AMA and RACGP resistance to anything that smells like a move toward capitation but it’s not real: Australia is not about to nationalise general practice.

The end game

Put it all together and the picture is less a conspiracy No 436 and more a government that knows roughly where it wants general practice funding to end up, doesn’t yet have good evidence that its preferred destination works at scale in Australia, hasn’t been successful in properly piloting the transition, and keeps reaching for whichever lever is closest to hand to nudge things along.

Health Care Homes was no help unfortunately. That got us nowhere and wasted quite a bit of money.

Still, we were trying.

AoB might be the clumsiest and most damaging lever we’ve pulled so far: disproportionate to the problem, expensive for practices, and genuinely capable of producing the opposite of its intended effect.

Meanwhile, a meaningful and growing share of how Australians actually get GP-level care is already happening on a salaried or quasi-salaried basis, through urgent care clinics, corporate consolidation and telehealth platforms.

Whether that’s a good thing depends on who you ask and what you value about general practice. But so far it’s not even in the conversation interestingly.

The government never had the wrong long term idea with MyMedicare.

It just sucks at understanding the basics of engagement.

They need to scrap AoB as a sign of good faith, and start thinking a little harder.

I’m looking forward to downloading the MyMedicare app when it’s finished in about one year’s time.

I figure if the department and the Australian Digital Health Agency really put their minds to it, that’s doable, albeit not quite all the bells and whistles I’d like in version 1.0, I’m sure.