Bulk-billing rates tumble into 2023

3 minute read

A new report quantifies GPs’ declining reliance on MBS rebates.

New research has revealed the continuing decline of bulk billing in the metro capitals as well as all of the NT, ACT and Tasmania.

Just 42.7% of clinics in these cities and territories offer bulk billing to every patient, according to a report released over the weekend by GP clinic comparison website Cleanbill, which says it’s the largest ever survey of Australian GP pricing practices.

Outside Sydney and Melbourne, bulk-billed care is even harder to find, with fewer than one in three GP clinics bulk billing all patients, while in Tasmania and the ACT the figure is down to one in 20.

Average out-of-pocket costs at the 57.3% of GP clinics that do not bulk bill all their patients sit at $40.25 for a standard, 15-minute consultation.

The report also revealed the difficulty in accessing primary care, with almost one in 10 clinics surveyed saying they were no longer taking on new patients.

To produce the comparison site’s listings, a team located, called and listed full information, including prices, for 4,188 GP clinics in each Australian capital city, as well as the entire NT, ACT and Tasmania.

Cleanbill owner and founder James Gillespie told TMR the legwork was done by around 13 contractors – primarily uni students – between August and December 2022. The website and survey are funded by Mr Gillespie himself.

The research is claimed to be the most comprehensive survey yet undertaken on the state of primary care accessibility in Australia, with listed clinics covering around 70% of the Australian population.

The report also reveals significant differences in bulk-billing rates across jurisdictions. While Australia-wide, 3819 clinics were designated “available” – accepting new patients – only 1595 bulk-billed, representing 42.7% of those surveyed.

Patients on the hunt for a bulk-billing clinic are best placed if they live in Greater Sydney, where the report found 1198 available clinics, of which 804 (67.3%) bulk billed. By contrast, the ACT had 100 available clinics, with only five offering bulk-billing, representing a rate of 5.1% (since one clinic contacted did not provide a quote).

In the NT, just seven of the 34 available GP clinics bulk bill, representing 20.6%.

Average out-of-pocket costs also varied, with a national average of $40.25. However, in Greater Adelaide which has the lowest out-of-pocket figure, patients could expect to pay an average $34.81, while at the other end of the scale, Tasmanian patients are paying around $47.44 and the ACT has the largest average out-of-pocket payment at $49.01.  

The decline in bulk billing has escalated over the past couple of years, periodically attracting media attention – particularly when it comes to more vulnerable patients, including those with complex and chronic conditions who need regular appointments.

However, practice viability as well as patient care has been at the forefront for GPs and at the end of 2021, RACGP immediate past-president Adjunct Professor Karen Price took the bold step of encouraging practitioners to move away from bulk billing. The RACGP also offered materials and support on how to develop mixed-billing structures.

The college has also warned that bulk-billing rates alluded to by past governments have emphasised the proportion of services billed rather than the percentage of patients that have all their costs covered.

“We know in the previous term of government there were claims that bulk billing was sitting at a healthy 88%,” RACGP president Dr Nicole Higgins said last month. “But a more critical look at the data revealed that the percentage of patients who had all their GP care bulk billed was sitting at just two-thirds nationally in 2020 and 2021.”

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