In line with a growing national trend, GPs in regional South Australia are scrapping bulk-billed appointments for some patients.
Medical clinics are flagging doctor burnout and financial reasons for the changes, which will mean out-of-pocket expenses for many people.
Consumers Health Forum of Australia chief executive Leanne Wells said many clinics across Australia were changing their bulk-billing practices.
"I think it is quite clear that people can't expect go to their doctor expecting to be bulk-billed anymore," Ms Wells said.
Ms Wells said this was particularly hurting patients on low incomes and with chronic health conditions and that the system needed "widespread and transformational" reform.
"The concern is that our universal Medicare system is no longer universal," she said.
"When people have to think about basic healthcare as a discretionary expenditure that they weigh up alongside other household purchasing decisions, really we need to be getting back to thinking about access to basic healthcare as a right."
'Lack of investment'
Two clinics on the Limestone Coast have recently announced changes to bulk-billing arrangements.
Naracoorte's Kincraig Medical Clinic will cease offering bulk-billed appointments from July 1, requiring all patients to pay an out-of-pocket cost, including concession and pension card holders.
Pension card holders will receive a reduced gap.
Clinic partner Jeff Taylor said the frozen Medicare Patient Rebate had failed to keep up with rising costs.
"Over that time the costs of providing medical care have gone up and up, especially with the pandemic, staff salaries are going up," he said.
"My insurance this year has gone up 18 per cent.
"Unfortunately, successive governments have not invested into general medicine, or to general practice — especially in rural areas.
"Now we're seeing the effects of that lack of investment."
No doctor on call
This week the Medical Clinic Millicent also announced it would no longer bulk-bill or discount urgent "on-call" appointments as of July 4.
Practice manager Bronwyn Barker also flagged changes to the way urgent appointments were made, because no on-call doctor would be available daily.
Instead, calls would be triaged by the clinic's reception staff and appointed by urgency and appointment availability.
"Come July, we're going to be short two doctors from what we have currently at the moment, and those two doctors now take up the bulk of the on-call doctor appointments available each day," Ms Barker said.
She said patients should still be able to call and access urgent appointments, but they would pay a full fee.
That will apply to children and concession and pension card holders.
Ms Barker said the clinic's GPs were working longer hours and using their time off to keep up with demand.
"I'm very concerned for our doctors that are here currently," she said.
"At some point, something's going to break, and I don't want it to be the doctors that are staying here and their practice."
Government vows to act
In a statement, federal Health Minister Mark Butler said Labor was committed to making it easier and more affordable to see a doctor, and had promised $146 million in initiatives to deliver more doctors in rural and regional Australia.
The government recently announced a Strengthening Medicare Fund, which promises improved patient access to General Practice, allied healthcare and greater patient affordability.
Meanwhile, SA Health Minister Chris Picton said while funding and support for GPs and Medicare was the responsibility of the Federal Government, his government had committed funding for hospital redevelopments and upgrades, as well as more staffing, beds and ambulance services.
"When I was in Mount Gambier this month, I heard first-hand there is a noticeable impact on people presenting at the Mount Gambier Emergency Department because of a lack of available primary health services.
"Addressing the shortage of primary care was a key part of the discussion about health reform at National Cabinet on Friday with a new health reform review established."
