Budget incentives aimed at GPs are unlikely to increase the number of bulk-billing appointments available, or prompt clinics that have moved to private fees back to providing bulk-billed care, health policy experts and GPs say.
A health policy analyst and former senior public servant of two decades with the federal department of health, Charles Maskell-Knight, said the bulk-billing incentive increases announced in the budget will encourage GPs already bulk billing to keep doing so, but will not reverse the trend of practices charging some patients a private fee or scrapping bulk billing altogether.
From 1 November the amount of money the government pays GPs as an incentive for bulk billing will triple to $20.65 instead of $6.85 for a standard consultation. GPs working in very remote areas will receive $39.65. This is not the total GPs receive from the government for bulk billing (where a patient pays nothing for their appointment), but is a government payment GPs get paid on top of the Medicare rebate to encourage them to bulk bill.
“If you are a GP currently charging patients a gap fee of $50, then unless you get the same amount of money from changing to bulk billing, you’re not going to change as the extra incentives are nothing close to that much,” Maskell-Knight said.
“It’s just doesn’t make economic sense. It might stop bulk billing from going backwards for now, but it’s not a long-term solution.”
“The problem is we are obsessed with fee-for-service medicine, and we need to try and get away from that idea. We need to also pay people for being doctors, and pay them a capitation payment, which would cover following up with family, following up with staff, talking to specialists and all of that care.”
In other words, rather than a GP just being paid an incentive for giving a single short consult, they would be also be incentivised to provide holistic, integrated care across a number of services.
In an analysis of the reforms for the Conversation, health system expert Dr Stephen Duckett said “it’s unclear” whether the budget measures will increase bulk-billing rates.
“Practice owners could simply pocket the increased incentive for patients who are already bulk billed, leaving bulk-billing rates unchanged,” Duckett said. “Or GPs could use the increased revenue from their existing bulk-billed patients to reduce their hours of work, rather than bulk billing more patients.”
President of the Royal Australian College of General Practitioners, Dr Nicole Higgins, said the funding gives GPs more flexibility to support their vulnerable and disadvantaged patients, which she said is especially important for rural patients. But on whether bulk-billing rates will increase, she said: “We will have to wait to see the real impact of this measure in the Medicare benefits schedule data.”
“But I am optimistic,” she said. “Taken with the rest of the measures in this budget, this is a gamechanger budget for general practice, and it will make a difference for patients, particularly those who are most vulnerable.”
Dr Tim Senior is a GP who works in Aboriginal and Torres Strait Islander health, and the western Sydney clinic where he works bulk bills all patients.
“We will actually benefit from these budget measures because it will just increase the amount of money we’re getting for doing the work that we were already doing,” he said.
“So I think the GPs who are already bulk billing healthcare card holders, pension card holders and children will benefit. And I think for GPs who really want to bulk bill because their patients are vulnerable and who have been forced to close their clinics because their patients can’t afford to pay a fee may return to bulk billing.
“But the extended Medicare rebate freeze has created a real lack of trust. There’s a lot of talk among GPs about this measure being a trap, because what we really need is long-term funding that keeps pace with the cost of providing care, and these incentives are not enough to address that.”
Overall Senior does not think there will be meaningful changes to bulk-billing rates as a result of the incentive. The increased incentive payments only apply to GP consultations with children under 16, pensioners and other commonwealth concession card holders.
“I think the increased bulk-billing incentive is a really good health equity measure, because it targets those who are most likely to need help to pay for services,” he said. “But the budget measures won’t make any difference for people without a concession card. There’s no extra incentive for bulk billing them.”
