It’s getting harder and harder to find a bulk-billing doctor — and it’s even harder to discern their fees. New analysis, which involved calling scores of GP clinics across the country to determine their billing practices, has found just 4% of clinics in the ACT and Queanbeyan offer bulk billing. Analysis into other states is still underway.
As revealed by The Sydney Morning Herald this morning, rates of medicare fraud are staggeringly high, costing the taxpayer up to $8 billion a year. As inflation bites the few clinics that legitimately offer bulk billing, services will continue to dwindle, experts warn, arguing the Medicare rebate is simply not enough to cover costs.
Billing transparency is muddy
Cleanbill is an online resource that aims to publish the pricing of practitioners across the country. Founder James Gillespie and a small team have, through both automated processes and the laborious task of calling individual clinics, collected pricing, location and contact information of healthcare practitioners.
The organisation found that of the 100 clinics in the ACT and Queanbeyan (all but one provided a pricing quote), just four offered bulk billing. The average out-of-pocket cost for a standard consultation was $48.92, while longer consultations averaged out at $66.65.
“The national-level studies you need to do to prove [bulk-billing rates] empirically requires just an enormous amount of work,” Gillepsie told Crikey.
Gillespie’s research began in 2018 when he highlighted the “postcode lottery” of bulk-billing practices. His prior research didn’t elicit much response from the government, but he hopes this time will be different.
“The national feeling around bulk billing is very different now to what it was four years ago [when] people weren’t as worried about the cost of living and bulk-billing rates as they are now.”
According to the Royal Australian College of General Practitioners (RACGP) Health of the Nation report, just 24% of GPs bulk bill all of their patients, while this past financial year has seen a fall in the proportion of GP services bulk billed for the first time in almost 20 years.
Australians made more than 500 million trips to the doctor last financial year. But as revealed earlier this year, as few as 30% of patients were being properly bulk billed, with some practices illegally collecting a separate out-of-pocket cost, but listing the service as bulk billed through Medicare.
Clinics ‘struggling to survive’
Cornerstone Health CEO Henry Bateman — whose healthcare company establishes large-scale bulk-billing clinics across the eastern states — told Crikey the trend away from bulk billing had been noticeable since April as inflation worsened. Cornerstone Health is also feeling pressure to implement a co-payment due to the low Medicare rebates.
“We’ve had this huge influx of patients into our practice as all the practices in the neighbouring areas have largely stopped bulk billing,” he said, pointing to Loganholme in Queensland, Williams Landing in Victoria, and Penrith in NSW as key areas of concern.
“I speak to lots of doctors outside of my own network. And they just say, ‘No, we can’t financially survive anymore. We can’t carry the cost anymore.’”
From a business perspective, increased demand should be a good thing for Bateman. But soaring inflation and staff shortages are biting Cornerstone Health too.
“We’ve got the benefits of being a bigger group and the benefits of scale, so the costs are shared across a large number of doctors. But everyone has their breaking point,” Bateman said.
He said there’s been a surge in demand for nurses to administer COVID-19 and influenza vaccines, but while they were rightly paid a premium for their work, that premium saw a 25% increase in costs over the past four months.
The increasing cost of supplies coupled with extreme staff shortages — caused by staff getting infected with COVID-19 or the flu, career burnout, and a shortage of students entering the industry — things had been brutal.
“It’s a pretty acute moment,” Bateman said.
‘Morally hazardous’
Queensland chair of the Royal Australian College of General Practitioners Dr Bruce Willett told Crikey issues had been longstanding since the Medicare rebate freeze from 2013 to 2019. It means some medical professionals are being reimbursed the same amount this year as they were in 2014. He said getting payments from patients was a massive stressor for doctors.
“I’ve had some patients for 30 years. But particularly for aged care pensioners, co-payments are a significant amount of their pension so I can’t ask them to do that,” he said, adding it was “morally hazardous” for doctors to pressure patients into new co-payments.
“On the other hand, I can’t afford to attract more patients because the ones I have tend to be quite high-needs. So that stress … is contributing to that massive increase in burnout [among practitioners].”
Official Medicare data states that the national bulk-billing rate is 82.2%, which takes into account all tests, checkups and trips to the doctor, and doesn’t account for fraud. Federal Health Minister Mark Butler announced $750 million towards a Strengthening Medicare Fund this year, but details of how the funding will be spent haven’t been announced.
Have you struggled to find bulk-billings GPs? Let us know by writing to letters@crikey.com.au. Please include your full name to be considered for publication. We reserve the right to edit for length and clarity.
Tony Abbott & Joe Hockey tried out co-payments back in 2014. It was a horror then and is worse now. Conservative Govts hate Medicare and have done their best to destroy it. Sadly, it’s looking like they may have succeeded.
As an aged pensioner, I cannot begin to describe just how much angst and frustrated hatred the current batch of coalition MP’s engender in my psyche.
Thank you for continuing to pursue this Amber. A true bulk billing rate of 30% sounds right and all credit to Jane’s Gillespie for his painstaking work. I suspect true bulk billing rates are even lower here in Perth.
For those of us who can afford to pay, the biggest issue is getting in to see the doctor. My practice feels obliged to take new patients in the area but wait times are commonly over 2 weeks. There used to be appointments reserved for “on the day” urgent cases, especially children, but these are harder to come by. No wonder the emergency departments are full.
Could you please report on possible responses, perhaps from think tanks like Grattan, or agenda items at National cabinet?
Keep up the great work!
bloody John Howard!
Wasn’t it bloody Abbott and cigar-chomping Hockey?
“New analysis, which involved calling scores of GP clinics across the country to determine their billing practices, has found just 4% of clinics in the ACT and Queanbeyan offer bulk billing.”
Dealing with one of these clinics taught me a valuable lesson in that you get what you pay for. Worst experience with a doctor in my life! I’ll put up with a copay (lucky I’m in a situation where I can do that) to stay away from the bulk billing system.
Though it does concern me that bulk billing becomes a 2nd class service for those who can’t buy their way out of mediocrity. Good quality healthcare should be a right, not an privilege, and the implications of barriers to care will have wider negative implications on society.
In my community of some 650 plus citizens our Territory Govt Health Dept does not provide a health service at all, zilch!
Wasn’t there something called Mediscare a couple of years back, alleging changes to billing and general under funding of rebates to starve the system to point of collapse?
Aren’t we lucky that this government won’t allow such an occurrence?
The “death by a thousand cuts” approach to transforming a public service by a private sector takeover.
From “everyone deserves healthcare” through “everyone who can pay deserves healthcare” to finally “what’s healthcare *worth* to you?”
The USA spends more on health care than any other country (as with its War Dept, which hasn’t won a war since the Spanish America in the 19thC – discuss) yet has worse overall health, for a greater proportion of its citizens, than many developing countries.
Certainly for maternal and peri/neo natal far worse death rates that Cuba.
Wealthy Cuba has 5.9 doctors per 1,000 people and poor USA 2.5.
Given that it’s less than 150kms away one might expect that they’d ask for some advice and assistance in running a health service.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645168/
Looking at how socialised medicine is implemented around the world, I’m left to conclude that our system would look very different if what we cared about what is the best value for money. And really as a public service that’s what it should be about. Because what we have now says that we are more concerned with how private enterprise can make a buck from the system than we are having a healthy population.
The same seems to go for Aged Care.
It would be an interesting exercise to see what a people-centric cost-effective healthcare or aged care policy would look like if the systems were designed from scratch and didn’t have to take into account the way the systems are now. I’d wager we’d get something quite different to what we have now.
I remember an anecdote from the anthropologist Dave Graeber where we talked about why The Obamacare act kept horrendously inefficient aspects of the healthcare system, and it was because there was no way to clean it up without putting a lot of people out of work. Turns out it’s better politically for people to do something redundant (and the costs associated with that) than it was to make the system better.
That political fear of ‘job loss’ applies in many fields, from coal mining, gambing esp animal racing, drug policy – will nobody think of all the cops, lawyers, screws and other enforcers who might have to do something more useful, or at least less harmful, to society.
The list goes on, PR flaks, advertising, lobbyists. Unemployment would soar amongst the ‘better/wrong sort of’ voters.
So it goes.
I mean, I get it. Kicking a lot of people out of work at the same time is never a good thing for society, or for the people who are deemed superfluous. It would be a brave politician who said “this is the societal upheaval we had to have” even if in the medium-to-long term we would all benefit from it.
I heard some first hand stuff recently around the horrifying state of privatised, in the home aged care that literally has my eyebrows going through my hair line. This was one of the workers, crying while she’s telling me the state of some of her clients that are paying through the nose.AND that the government kicks in a subsidy for. And nobody’s getting what they’re paying for.
Yep. Infant mortality has been worse than Cuba’s for decades. And I believe average population life expectancy has recently dropped below Cuba’s as well – compliments of all those life-is-sacred libertarian anti-vaxxers and anti-lockdown Covid conspiracy theorists.