Claims by the former government that most patients are being bulk billed are “not honest”, the federal health minister, Mark Butler, has said, as a taskforce prepares to examine why basic health care is increasingly unaffordable.
In December the previous Coalition government said GP bulk-billing rates were at a “record high” of more than 88%, with almost nine out of 10 visits to the GP in 2021 resulting in no out-of-pocket cost for the patient.
But as Guardian Australia revealed this year, it is a rate that consumer groups and health policy experts have questioned. They say the bulk-billing figures have been artificially inflated by non-compliant billing practices, and that government statistics don’t reflect the number of people saying it is hard or even impossible to find a bulk-billing doctor.
When presented with these concerns, Butler said he had asked for more information from his department “to obtain a more complete and accurate picture of the state of bulk billing”.
“The former government was not honest with Australians about the true state of bulk billing in Australia by selectively quoting only this [88%] figure,” Butler said.
“Primary care is in its worst shape since Medicare began. Across the country we hear stories of Australians not being able to get in to see a bulk-billing doctor, or GPs changing from bulk billing to mixed billing.”
The vice-president of the Royal Australian College of General Practitioners, Dr Bruce Willett, agreed government bulk-billing figures were misleading and “significantly skewed”. He said that more patients, including those most disadvantaged, had been struggling to find a bulk-billing doctor.
“This 88% figure sounds impressive, especially since it was under 80% 12 years ago,” Willett said. “However, this is misleading and refers to total GP services.”
Some patients are being bulk billed for parts of their appointment but still paying out-of-pocket costs during many of their GP visits and for certain treatments, he said.
“On closer inspection, the proportion of patients who had all their general practice care bulk billed is only 67.6% nationally and as low as 64.4% in South Australia and 40.6% in the ACT,” he said.
Government bulk-billing figures were also skewed by Covid, Willett said. GP clinics have administered millions of Covid-19 vaccinations, all of which are bulk billed, and certain patient groups were bulk billed for all telehealth consultations for a large part of 2020.
“This means that the resulting bulk-billing data looks a lot rosier than is actually the case.”
The dwindling number of clinics that bulk bill is devastating for disadvantaged Australians.
Natalie*, who lives in Melbourne, is 50 and has Crohn’s disease, ulcerative colitis, and gastroesophageal reflux disease. She also grapples with the ongoing repercussions of complex childhood trauma.
As a result of a severe mental health crisis about eight years ago, she can no longer work and relies on income protection insurance payments, which she says have allowed her “to continue to survive without losing everything I worked for since I was a teenager”.
Natalie sent Guardian Australia her Medicare statement detailing her out-of-pocket expenses for the past three years.
Since August 2019, she has paid $3,232.40 in out-of-pocket expenses. This, Natalie stressed, was what it cost her even with doctors who try to bulk bill her as much as possible.
“In a bad year, I would be many thousands of dollars out of pocket,” she said. “And I consider myself hugely fortunate. I don’t know how people who aren’t as fortunate manage.”
A spokesperson for the Australian Association of Practice Management (AAPM) said for bulk billing to be profitable, it required a large number of patients to be seen each day.
This may be feasible for large super-clinics with multiple locations and doctors, but it was less viable for small family practices, which have fewer doctors and a greater proportion of longer appointments.
Butler announced a “strengthening Medicare taskforce” as part of Labor’s election platform and an expert panel has been established.
“Our strengthening Medicare taskforce will identify the best ways to boost affordability, improve access, and deliver better support for patients with ongoing and chronic illness, backed by the $750m strengthening Medicare fund,” he said.
But the AAPM chief executive, Miranda Grace, said it was “utterly bewildering” the taskforce’s expert panel did not contain anyone with expertise in medical practice management.
“The exclusion of practice managers shows that minister Butler has a complete lack of understanding in how practices operate,” Grace said.
On top of this, Medicare rebates for GP consultations haven’t kept pace with the cost of providing quality care, and running a general practice. These costs are now being passed on to patients.
“While Medicare rebates for most GP appointments did rise on 1 July this year, it was only by a miserly 1.6%,” Willett said.
Meanwhile, attracting people to the profession is getting tougher. Just 16% of medical students consider general practice as their preferred specialty, Willett said. A Deloitte report, published in May, projects that by 2032, there will be a shortfall of 11,392 full-time equivalent GPs across Australia.
The recently elected president of the Australia Medical Association, Prof Steve Robson, said addressing the crisis of access to GPs and attracting students to general practice will be one of his priorities in the role.
“It is one of our incredible challenges at the moment,” Robson said. “General practice is the heart and soul of healthcare in this country and priority number one has to be asking; ‘how can we help general practice survive?’.
“General practitioners save more lives than any other single group in this country, they provide more care, and they are loved by their patients.”
*Name changed to protect identity
