Even though it’s been a scant three months since bulk billing changes went live, the federal government will seek to work out whether the cash influx has made a difference.
The senate committee managing rural and regional affairs has launched a probe into whether last year’s Medicare changes have made a positive impact on access to primary care for rural Australians.
Terms of reference include the financial sustainability of independently owned rural GP clinics under current Medicare funding and incentive structures, the adequacy of Medicare support for mixed-team models of care in the regions, the impacts of Medicare rules and incentive arrangements on large corporate providers compared to small clinics and the reforms needed to ensure Medicare is fair for rural Australians.
Given that the most recent swathe of changes to Medicare – namely the bulk billing PIP and the expanded bulk billing incentive – came into play just three months ago, it’s unclear how definitive the parliamentary review will be.
“Anecdotally, a lot of people are cynical at worst and hopeful at best that the incentives, as well as the item numbers, will keep pace with the cost of doing business and of providing that service,” ACRRM president Dr Rod Martin told The Medical Republic.
“The great peril will be that it is good [right now], but in two years’ time, those practices will be back to where they were, because [the cost of] everything else is raised more than the top-ups of the incentives.
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“There may well be CPI indexing, but medical CPI and standard national CPI often don’t match each other.”
In terms of the reforms needed to ensure Medicare is fair for all rural Australians, though, Dr Martin already had strong ideas.
“Urgent care centres are a predominantly metropolitan and large regional function,” he said.
“They’re not in small regional towns and there’s not been a solution that has been proffered to try and give rural patients the same access to urgent care that metropolitan and large regional town patients have.”
To that end, the National Rural Health Alliance estimates that rural Australians miss out on around $1000 in healthcare funding per person per year compared to their metropolitan counterparts.
“There are whole parts of the model that are missing,” Dr Martin said.
Rural Doctors Association of Australia president Dr Sarah Chalmers told TMR that there were inherent problems in trying to compare health spends across metro and rural areas.
“Spending in rural and remote obviously has a different focus than in town, but because of the incentives, it looks like you’re spending more, but it’s not necessarily for more services,” she said.
“If you took $100 it might only be one-and-a-bit consultations in an MM5 location, but it’s probably more like two-and-a-bit consultations in a major centre.
“It’s not comparing the same things.
“If you’re just looking at Medicare spend, we also know that, because of workforce distribution issues, if you don’t have people on the ground, then there’s only so much that increasing incentives and all those sorts of things will do.
“[Data] is only ever going to be part of the story.”
The senate committee is due to report back by 30 June 2026.
