Pensioner Paul Bevington skips dinner three times a week to make seven days worth of groceries last a fortnight.
In his daily struggle to survive, sometimes he thinks the only thing keeping him going is the love of his dog Possum.
"I'll go hungry before I make her go hungry," he said.
Adding to the pressure, he can't find a general practitioner who will bulk bill his medical appointments in his hometown of Alice Springs in the Northern Territory.
Mr Bevington lives with multiple chronic health conditions and needs to see a doctor around six times per year to renew his prescriptions.
He pays a gap of $51 each visit, which comes out of his budget for groceries and fuel, meaning he can not leave his home at a caravan park on the outskirts of town as much as he used to.
"At the moment, when you're basically stuck in four walls, you tend to go … stir crazy," he said.
"And that's about where I'm getting.”
Hopes new bulk billing scheme will provide relief
A measure announced in this year's federal budget aims to encourage more doctors to deliver free healthcare to concession card holders, under 16-year-olds, and pensioners like Mr Bevington, by tripling the "bulk billing incentive" – the amount of money the government pays GPs to bulk bill.
That measure is likely to have the greatest impact in regional and remote areas like Alice Springs, where the costs of running a GP clinic are higher, according to Royal Australian College of General Practitioners (RACGP) NT Faculty chair Sam Heard.
Dr Heard said, as a result, there were no bulk-billing GP practices left in Alice Springs, except some specialist Indigenous primary health services.
"Because of all the added costs of being a very remote centre, it becomes almost impossible to have anybody that you bulk bill – if you bulk bill many people at all, you're really going to be in trouble,” he said.
Dr Heard said the new measure would likely change that equation for GPs in areas like Alice Springs, compensating them for the income they lose by not charging their patients a gap fee.
However, he warned the measure could make it more challenging for people who don’t hold a concession or pension card to find a doctor who bulk bills.
"It's less likely that you will be bulk billed if you're employed now because the GP will be paid the least for somebody who can afford to pay … so as a GP it's obviously going to be quite a hit on your pocket if you bulk bill people who don’t have a health care card," he said.
'Is it going to kill me?'
Mark Black, who lives in Darwin, said the rising cost of living is making it challenging for him to afford regular appointments to get prescriptions for medication to manage his diabetes, even though he works full time.
He does not hold a pension or concession card, and said he had previously gone without medication because he did not always have the money to pay for the full cost of his appointment before his Medicare rebate was applied.
"It's a bit scary. It means I wonder, 'is it going to kill me?'," he said.
"That's the worst-case scenario I suppose."
Dr Heard said people who, like Mr Black, were employed but struggling with the costs of appointments should look at applying for a healthcare card if they were receiving income support, or putting the cost on a credit card.
Robert Parker, president of the Australian Medical Association NT, said a series of 50 “Medicare urgent care clinics", which the federal government committed to during the election, should also help to ease some of the pressures faced by patients who were not being bulk billed.
The first two urgent care clinics are set to open in Darwin’s satellite city, Palmerston, and Alice Springs, midway through the year.
“People will be able to get free primary care through these urgent care centres,” Dr Parker said.
“Hopefully these urgent care centres will address the problems that people are fearful about."
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