Julie Mallinson is managing her severe lymphedema, chronic pain and frequent infections at home because she can't afford to see a doctor.
The 51-year-old's lymphedema — an incurable disorder of the immune system — causes extreme swelling in both legs and constant pain.
"It's basically like someone is inside your leg pushing your leg from the inside out," she said.
"On top of that, you have this stabbing feeling that brings you to tears, it makes you want to cry.
"I have to live with that all the time. It doesn't go away."
She should be seeing a GP fortnightly for prescriptions for pain relief and to manage her infections — but she hasn't had an appointment for over eight months after her local clinic in Tasmania stopped bulk billing.
The disability pensioner said she simply could not afford to see a doctor.
"We have to make sure our rent is paid and we have to pay the power bill and we've got to make sure we've got food … so you don't have money laying around," she said.
It has meant Ms Mallinson has been managing her infections at home.
"I will be sitting underneath my blanket with the chills from the temperature.
"My leg will be red raw. I will be in so much pain, and I run the risk of having cardiac issues."
Her daughter and carer Sam Mallinson made numerous phone calls trying to find a new bulk-billing doctor in the area and beyond but she was unsuccessful.
"I was shocked," Ms Mallinson said.
Tasmania's bulk-billing rate lowest in the country
Sam, 30, has also struggled to access free healthcare.
She has been waiting 1,000 days to see an orthopaedic surgeon and her daughter has been waiting over a year to see a paediatrician.
"Angry is probably the feeling that comes to mind the most, but also upsetting," she said.
Julie Mallinson fears Australia's health system is becoming more like the United States model.
"We're supposed to have free health care. It's not free, it's not free at all," she said.
She said despite her health condition she tried to keep a positive attitude and "see the good in everything".
But she said she federal and state governments needed to do more to fix the healthcare system.
"I live in hope that it will get better so that my granddaughter can grow up and be able to access basic things," she said.
The Mallinsons live in Tasmania, which has the lowest bulk-billing rate in the country.
Federal Health Department figures show 44.8 per cent of Tasmanians are always bulk-billed at the GP compared to 51 per cent over a decade ago.
The Productivity Commission says 7.6 per cent of Tasmanians avoid seeing a doctor for financial reasons — the highest rate in the country.
Nationally, the bulk-billing rate dropped from 87 per cent to 83.4 per cent between July and September, down from 88.4 per cent the year before.
The President of the Australian Medical Association, Professor Steve Robson, said many practices just could not afford to do it.
"If they bulk bill it means they are accepting the payment the government gives them for seeing a patient," he said.
"We know that payment has been frozen for a long time and now is crawling up at a snail's pace.
"With inflation the way it is, small business general practices just can't afford to do it anymore."
He said the average consultation cost a practice around $90, but "the government will give them back less than $40".
"It's really important the government looks at how much they're prepared to chip in for that $50 that's missing so as to increase the bulk-billing rate," Professor Robson said.
While he welcomed the federal government's plan to strengthen Medicare, Professor Robson said there also needed to be a significant lift in the rebate or "it's impossible to see how bulk-billing rates could do anything but plummet".
Transparency 'the first step'
Federal Health Minister Mark Butler said in a statement the Morrison government had hidden the "shocking decline of bulk-billing", and that in the year to June 2022, fewer than two-thirds of Australians had all of their GP visits bulk-billed.
"Vaccines and other COVID-19 measures hid the true extent of the decline in bulk-billing under the Morrison government," he said.
"Those measures artificially inflated the figures while keep a short-term flow of rebates into general practice, cross-subsidising doctors to provide other care.
"My department will now regularly publish the data on how many Australians have all their visits to the GP bulk-billed. Being transparent with the public is the first step.
"I will continue to engage with all health care stakeholders, including consumer groups, unions and doctor groups to ensure we increase affordability and deliver our reforms to strengthen Medicare."
Calls for overhaul of primary care health funding
The health director at the Grattan Institute, Peter Breadon, said bulk-billing rates varied widely depending where you lived in Australia.
"In south-western Sydney, about nine-in-10 patients are always bulk billed," Mr Breadon said.
"In areas like country Western Australia, Northern Queensland and in some places like Tasmania and Canberra it's less than half of people."
He said deeper reforms to the way primary health care was funded were needed.
"The shortest possible visit will get higher payment for the GP, so that rewards this churning through patients as fast as you can," he said.
Mr Breadon is proposing a new funding model which would pay GPs more for treating people who are sicker and in need of longer consultations.
He also suggested funding a bigger team to support GPs.
"It would mean putting physiotherapists and psychologists and nurses and other kind of workers into the GP clinics [to] help provide that multidisciplinary care," he said.
Mr Breadon said in areas where there weren't enough health professionals, the federal and state governments needed to pool money to set up clinics or fund GP services out of small rural hospitals.
