While bulk-billing figures have been used to defend cuts, they’re about as useful as a chocolate teapot
GP bulk-billing figures used to justify the Medicare freeze are so riddled with confounders as to be meaningless, according to an expert analysis.
The true proportion of bulk-billed GP consultations may be as low as half the government’s claimed 85%, said Margaret Faux, a lawyer and CEO and founder of a medical billing company.
Yet the government has continued to use the numbers to defend the freeze, with Health Minister Sussan Ley saying the “only figure that matters here is the bulk-billing rate” when it comes to out-of-pocket costs for patients.
“Other figures that swirl around from time to time may be in the interests of those making the arguments, but what I focus on is the bulk-billing rate, and it has never been higher,” she said.
While the reliability of the bulk-billing figures has long been under suspicion, the new analysis identifies multiple factors that skew the numbers.
“The government statistic has created a false impression designed to mislead Australians into believing they will not have to pay to see a GP 85% of the time, but the statistic, in fact, has very little to do with whether patients are required to pay at the GP,” said the founder of Synapse Medical Services.
RACGP President Dr Bastian Seidel urged policymakers to move away from the focus on bulk-billing figures as a marker of quality in the healthcare system.
“It’s political spin to talk about the bulk-billing number,” he said. “We have no idea what we’re talking about and what the implications are.
“We are more concerned about how much patients are paying when they actually go and see the GP and we are concerned about how much funding has been put towards Medicare for GPs and their patients,” he said.
Instead, a more meaningful analysis of the healthcare system would be Medicare funding for general practice per person, per year, he said.
Earlier this year, the Coalition government claimed there were 17 million more bulk-billed GP attendances in the 12 months to August this year compared with Labor’s last year in office.
But Ms Faux said it was impossible to know how many patients were paying out of pocket, and how much, doubting the statistic was useful “on any level”.
“That figure is basically meaningless. All it’s doing is picking a random group of services and saying 85% of all of these services are bulk billed, which is meaningless,” she said.
Factors such as unreferred specialist and career medical officer use of GP item numbers, as well as attendances with some bulk billed and some non-bulk-billed services, are just some of the examples that distort the data.
“It doesn’t mean GPs are bulk billing them, it doesn’t mean more patients are being bulk billed, it’s just a group of services, and if we want accuracy we need to apply high-level filters to the data.
“Even then, you would get closer to the truth but you still would not know whether patients are handing over money when they go to the doctor because you can’t see it. It’s invisible.
“What we need to do is start understanding that Medicare is part of a really complex labyrinth, that is every bit as complex as family law,” she said.
“I suspect that the government itself does not understand who claims what and how Medicare is actually used at a grassroots level,” she said.
“Perhaps they don’t understand that a GP has a whole host of claiming options available in relation to billing patients. Not so much when it’s a single service, but there is a large percentage of patients that have more than one service, and that opens up a whole range of claiming possibilities and a whole range of options in relation to the way that a GP might structure that claim,” she said.
“No one will ever know. The only people who know are the patients themselves, because they are the people handing over the cash.”
For this reason, she said the RACGP’s study suggesting the bulk-billing rate was closer to 69% was a more accurate reflection of the true numbers – and potentially even too high.
“What we don’t know is whether the impact of the Medicare rebate freeze has actually changed the true bulk-billing figures, because no one has measured that.
“Doctors are regularly blamed for rorting the system, yet there is no empirical evidence to support those claims. None.”
Instead, the dismantling of the Health Insurance Commission 10 years ago led to a loss of corporate knowledge in the system.
“You can call Medicare five times with the same question and get five different answers.”
For an in-depth look at the government’s rubbery 85% GP bulk-billing claim read Margaret Faux’s ‘Lies, damned lies and Medicare bulk-billing rates’.