... but comes back empty handed.
Shadow Health Minister Senator Anne Ruston has been forensically interrogating the figures and the spaces in between at Senate Estimates this week in an attempt to find out how the government is planning to get to 90% GPbulk billing by 2030 and if any of the GP practices that signed up to become fully bulk billing have thus far actually been fully bulk billing.
“I just want the big number. That’s all I’m asking for. Big number, broken down state by state,” said Ms Ruston.
Spoiler: she did not get much satisfaction.
“There is no quantitative measure at all that has been provided by the government. All this information is either not available or clearly being withheld,” Ms Ruston told Department of Health, Disability and Ageing staff in the hot seat, assembled ministers and online watchers of Senate Estimates this morning.
Ms Ruston was particularly concerned about an “explosion” in out-of-pocket services patients were being billed out-of-pocket in 2023 – “nigh on, well, pretty much since 2020/21 we’ve seen a doubling of the amount of services that are attracting a charge,” she said.
“I think the most likely reason was, and I think it was an exhortation by the then president of the Royal Australian College of General Practitioners for practices to move to mixed billing. That seemed to be coinciding with the increase,” said DoHAC deputy secretary Penny Shakespeare.
The then-RACGP president referred to – none other than Professor Karen Price – told TMR that practices were closing and that switching to mixed billing was better than trading insolvent.
“This is in law. You need to make sure your company is solvent, and if you’re not making ends meet, … you have to raise your prices.”
Professor Price said GPs were trying to subsidise patients that needed it – just as the government was trying to, but at a local level.
“And the government is saying, ‘oh, you’re doing the wrong thing, because everything should be free’.
“Well, we can’t keep the doors open, Minister. The professional vocation has been missed by the class who count beans, because they just think it’s all about the patient sitting in front of us. “It’s not. It’s about doing CPD. It’s about being rested and not burned out. It’s about teaching the next generation. It’s about doing home visits. It’s about reviewing results and paperwork and having the time to do that.
“And you can only do that if you’re paid enough.”
As at 30 November, 2902 GP clinics had signed up to the government’s bulk billing incentive payment (BBPIP). Of those, 1675 (58%) were already fully bulk billing before signing up, 1092 were mixed billing and 135 were entirely new to MyMedicare “and didn’t have established billing information”, the department told Senate Estimates.
The department could not tell Senator Ruston if the number of registered practices was the same as the number of practices who were, in fact, fully bulk billing, because the first quarter of the program was still underway.
The department explained that registered clinics would need to have been fully bulk billing for three months to be eligible for the practice incentive payment, and thus had to decide at the beginning of the quarter whether they would be fully bulk billing.
Those practices would then be back-paid the practice incentive payment around the end of January to cover that previous quarter.
“But in terms of the first month’s worth of data, which is still new … we have seen a significant increase in the number of bulk-billed services,” said DoHAC deputy secretary Penny Shakespeare.
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The department said there were 10.8 million bulk billing claims in November, compared with 7 million in October, and that 81.2% of GP visits were bulk billed in November, up from 77.7% in October.
“That’s entirely reasonable,” said Ms Ruston, responding to the department’s caution about the very early numbers.
“But the minister seems to be running around using this data quite frequently. So, clearly, it must be in a state that’s good enough for him.”
Ms Ruston suggested that the number of practices registered with Services Australia to fully bulk bill was not necessarily the same number that would actually do so.
But DoHAC secretary Blair Comley thought that was unlikely.
“If you’ve registered, you’ve done so because you’ve decided, as a practice, this is your business model, and that you’ve collectively done that as a group of GPs to make the trade-off between some out-of-pocket expenses versus receiving the bulk billing incentive.
“So, we won’t know for certain until that reconciliation occurs, but you would think that practices trying to achieve the bulk billing incentive need to have decided upfront that this is the practice they intend to make,” he said.
A verbal tussle ensued when Ms Ruston tried to find out what the yearly targets were for getting to 90%.
“When this measure came into play, the bulk billing rate was about 77.9%, depending on which figure you want to extrapolate. And you’ve said that by 2030 you want it to be 90%.
“Surely you have got a trajectory that says each year you are hoping to increase the bulk billing rate by a certain amount to get from 77.9% to 90%. Do you have that data?” asked Ms Ruston.
Pressing the point, she clarified: “In 2030 you want to be here. What is your expectation of the bulk billing rate, then, at the end of 25/26, at the end of 26/27, at the end of 28/29 and the end of 29/30?
“What is your expectation? Or are you just going to go, ‘we’re 77.9% now and in 2030 it’ll be 90%?”
“It’s, in fact, over 81% now,” Ms Shakespeare pointed out (that number from the month of data the department had cautiously shared).
The department told Senate Estimates that the health department funding for the GP bulk billing practice incentive program was $2.3 billion over the forward estimates ($251.3 million in the first year, $517.1m in 25/26, $755.7m in 27/28 and $816.6 in 29/30).
And for the bulk billing incentive payments on the MBS it was $848.5m for this financial year, $1.398b for 27/28, $1.4963b for 28/29 and $1.549b for 29/30.
That was not including the $211.7m over the forward estimates for the Services Australia budget component of the programs.
The hearing continued after lunch. Watch the whole thing here.
