The Royal Australian College of GPs has led the argument that access to bulk billing is falling across Australia and is now well below the 88% claimed by the previous government and the 82% published by the Department of Health in last week.
On Thursday, Health Minister Mark Butler said the former government’s 88% figure had been reached through “selective pricing” of bulk billing. Butler said he had requested more information from his department “to get a more complete and accurate picture.”
Asked whether Medicare rebates to GPs should increase, opposition health spokeswoman Anne Ruston said the Coalition would present its health policies before the next election.
Stephen Duckett, a health economist and honorary professor at the University of Melbourne, is concerned that too much is being made of the drop in bulk billing, which he says has fallen by 1 to 2 per cent in the past six months.
“Whether this decline continues, we don’t know yet,” says Duckett, a former federal Health Department secretary who now sits on the Albanese government’s Medicare task force, which will report later this year.
Duckett says there could be a case for extra funding for GPs, who the Australian Bureau of Statistics found in 2021 had an average pre-tax weekly salary of $3300, or about $172,000 the year.
But he also says that increasing rebates for GPs is not the only way to find money to help maintain Medicare. “Maybe you decide to give other payments; to the nurses to reduce their waiting times, things like that. It’s a very complex issue.”
The Royal Australian College of General Practitioners says only 64 per cent of GP trips were bulk billed, according to its 2021 Health of the Nation report on general practice billing methods. For GPs who charge a fee in addition to the Medicare rebate, the average out-of-pocket cost to patients was about $39. The report also found that a third of doctors planned to increase these fees by 2022.
A survey by the college of its GPs last week found that a quarter of those who currently do not charge their patients plan to introduce a co-payment in the future.
University president Karen Price says that unless greater investment is made in general practice, “more and more practices will have no choice but to pass the cost on to patients or close their doors”.
For Hopkins, if those costs had been passed on when he started seeing his GP, Dr Paul MacCartney, at a community health center in Fitzroy, the “dark path” he was on could have led to a much darker place.
“I guess he saved my life. He reassured me over and over again that things were going to be okay,” says Hopkins.
Over the past five years, psychological conditions, including sleep disturbances and depression, have been the most common reasons for GP visits. And mental health visits are on the rise.
Hopkins spent years visiting MacCartney and today considers himself at the forefront of the issues that dogged him for years. “I still suffer, but I’ve learned to manage it,” she says.
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The 60-year-old says that when he first started seeing MacCartney, there was no way he could afford even a $10 or $20 “gap fee” to see a GP.
Born in East Gippsland, Hopkins worked as a nurse in hospitals, mental homes and aged care. She left nursing about a decade ago as she struggled with depression and anxiety. Today, he says his part-time job as a “lollipop man” – an elementary school crossing supervisor – is much more relaxed.
Hopkins says that if he had been forced to buy a doctor who charged in bulk, he would have simply stopped going.
“You build a relationship with your GP. Paul and I have a great relationship. I can tell him anything.”
Crisis support is available at life line on 13 11 14.
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