‘Modest’ bulk-billing rise, but band aids won’t fix ‘festering sore’

5 minute read

Concerns remain that the measly 3.5% indexation of Medicare will ‘erode’ any growth and that, 40 years on, Medicare isn’t fit for purpose.

More than two million additional GP visits have been bulk billed since the start of the tripled bulk-billing incentive in October last year, including almost a million in May alone, new federal estimates suggest. 

But GPs remain concerned that the continued “under-indexation” of Medicare will “erode” any growth. 

In November 2023, the federal government began the roll-out its $3.5 billion investment to increase bulk-billing incentives.  

And according to the government, the incentives have already made headway. 

“Doctors’ groups have called our tripling of the bulk-billing incentive a ‘game changer’ – and close to one million additional free visits to the GP in May prove that it is one,” said federal health minister Mark Butler

“The pressure on general practice began when Peter Dutton was health minister and he tried to do away with bulk billing by introducing a fee on every single visit to the GP, and then started a six-year freeze on Medicare rebates. 

“This is a win all round – for patients, doctors and the health system – and it is helping make Medicare stronger.” 

In two years, the Labor government has increased Medicare rebates by twice as much as the former Liberal government did in its nine-year stint, through its $940 million in additional Medicare funding delivered last year and $900 million delivered this week, according to the Department of Health and Aged Care. 

The latest data published by the DoHAC showed 915,000 estimated additional free visits in May and an overall bulk-billing rate of 79% nationally. 

This marks a modest increase of 3.4 percentage points since the induction of the triple bulk-billing incentives. 

The biggest increases were seen in regional and rural areas, with an estimated 900,000 additional visits since the incentives, according to the government. 

While the RACGP championed the increases, GPs remained concerned that the low-ball MBS indexation of 3.5%, which took effect yesterday, would undercut any increase. 

With healthcare inflation for the year to April reaching 6.1% according to the ABS, the rebate just isn’t keeping up. 

Interestingly, Tasmania saw an increase of eight percentage points in bulk billing since October – the highest nationally – to 74.4% in May. 

Speaking to The Medical Republic, GP and former AMA Tasmania president Dr John Davis said that the “slightly better” bulk-billing increases in Tassie were most likely a product of the demographic – “older and poorer” – which was more likely to be using a pensioner or concession card and therefore benefit from the bulk-billing incentive. 

Overall, the increases remained “modest” across the nation, he said. 

“Medicare was great perhaps 40 years ago, but it’s not doing the job today.  

“Successive governments, of both colours, after 1983, year by year have failed to increase the Medicare rebate by anything that resembles CPI.” 

Dr Davis said the crux of the problem was twofold: Medicare may no longer be fit for purpose and the system is “completely disjointed”. 

“Medicare does its bit, the public hospitals do their bit, the private hospitals do their bit, the private insurers do their bit, but in no way is the care coordinated,” said Dr Davis. 

“Perhaps we need to look at a new model in the delivery of health care.” 

According to Dr Davis, no one is brave enough to take on the scale of health reform needed. 

“It’s much easier for a state and federal governments to blame [each other] rather than work together. 

“At the moment, all they’re doing is putting ever more tiny and tinier band aids on a festering sore. 

“At the end of the day, [the public] own the health care system and they’re just not getting the timely care at any level in the health system that they deserve.” 

Dr Davis warned against unnecessary substitution of responsibilities in the name of reducing pressure on the workforce. 

“We shouldn’t be substituting unnecessarily, everyone in the system should be delivering the care they are skilled to deliver at the highest level,” he said. 

“Build a better model of primary care where you’ve got true integration and true support for all levels: pharmacists support GPs, GP support pharmacist, nurses support GPs, GP support nurses, nurse practitioners are part of the mix. 

“If you can develop a model where we’re all working cohesively together, you will begin to deliver better health outcomes. 

“But again, I don’t think anyone’s interested because everyone’s got their own patch to protect and I no one wants to sit back and say, how do we spend dollars more wisely?” 

Apart from Tasmania, the highest increases were seen in the ACT (5.5 percentage points to 57%), South Australia (5% to 75.7%) and the Northern Territory (4.8% to 76.3%). 

New South Wales maintained the highest bulk-billing rate at 83.3%, a modest increase of 2.7% since October. 

Victoria saw a rise of three percentage points to 79.8% in May, Queensland 3.4% to 77% and Western Australia 4.2% to 72.6%. 

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