New bulk-billing incentives ‘stem bleeding’ as rates stabilise

5 minute read

But increases in rates varied across the country and will need continued investment to persist, says the AMA and RACGP.

The national bulk-billing rate for GPs has remained relatively stable, if not slightly improved, over the five months since the federal government implemented its bulk-billing incentive in November 2023, new federal data suggests. 

“But it is not the whole story,” AMA vice president Dr Danielle McMullen told The Medical Republic

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

According to the government, the incentives have already made a dent. 

Between November – when the bulk-billing rebates tripled for children, pensioners and concessions – and March this year, bulk billing has remained relatively stable at between 76.5% and 77.7% nationally. 

Speaking to TMR, Dr McMullen said that the incentives had “so far” achieved their aim, “to stem the bleeding and to make sure that our most vulnerable patients had better access to affordable care”. 

“GPs really are willing to use whatever incentives are available to try and make sure their patients have accessible, affordable care,” she said. 

“But it is not the whole story.” 

While the new data may be encouraging, it is less clear exactly what the numbers mean in reality and the long-term stability of the trend. 

“What we’re hearing on the ground is that we haven’t seen a return of wholesale, fully bulk-billing clinics,” said Dr McMullen. 

“That wasn’t the intent of this [investment], and nor would we expect that to be the outcome. 

“The minister has highlighted and echoed the fears that many of us have, that investments made by the federal government could be sucked straight back out by state governments.  

“We do need to address the uncertainty around payroll tax that’s still present in most states and territories.” 

Without continued investment, the “green shoots of recovery” in general practice, as coined by federal Health Minister Mark Butler, “will wither and die”, RACGP president Dr Nicole Higgins told TMR

Nationally, the increase in bulk-billing rates from October – before the new incentives were implemented – to March was modest (2.1%), but it varied from state to state. 

The highest increases were seen in Tasmania, with 5% (to 71.3%), the Northern Territory, with 4% (75.5%) and South Australia, which rose 3.7% to 74.4%. 

Rates rose only 1.6% in New South Wales to 82.2%, 1.7% in Victoria to 78.5% and 2.5% in Queensland to 76.1%. 

According to Dr Higgins, the data suggested that payroll tax may have a part to play in the bulk-billing rates. 

“Victoria, NSW and the ACT particularly, they’ve only had very low increases in bulk billing,” she said. 

“We know that the threat of payroll tax in those states and territories will completely wipe out bulk billing.  

“When you have a look at the figures for South Australia – which did have a significant increase in the bulk-billing rates – with the imminent changes with payroll tax, that will stop overnight as well.” 

While Dr McMullen said payroll tax was an uncertainty that needed attention, she was wary of drawing inferences to it from the data. 

“What we did see was in Tasmania where most of the Territory is classified regionally, we know there’s been big problems with accessibility and affordability of care there and lots of people with concession cards, we saw a bigger increase [in bulk-billing rates],” she said. 

According to Dr McMullen, as the most cost effective and accessible part of the health system, general practice and GPs need to be financially supported to provide “wraparound care” through GP-led, team-based models. 

“GPs have proven time and time again that they’re capable of, and excel at, whole person care and coordinating team-based care.  

“We really need to support models that encourage that type of care delivery for Australia.” 

The investment into general practice is also pulling more junior doctors into the profession, according to the government. 

ACRRM is set to take on 165 training places this year, 11 places more than its initial target. 

The RACGP also saw an increase of 88 trainee places from last year, to 1255. 

While these numbers were “significant”, there was a way to go, said Dr Higgins. 

“We need to fund our workforce, which means investing in our GPs in training to ensure that they’ve got parity with their hospital colleagues. 

“We currently have a significant number of NHS refugee GPs. We need to be able to ensure that they’re able to work in Australia and are supported.” 

Speaking to ABC News this morning, Mr Butler said the party was focused on implementing last year’s budget investment and would not disclose whether there may be further investment into general practice in the upcoming budget. 

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