Doctors are warning Australians to temper their expectations of free GP visits as they fear patients will be disappointed when most city clinics keep charging gap fees, despite both Labor and the Coalition pledging $8.5 billion to boost bulk-billing.
As both parties try to sell voters on their healthcare records ahead of the federal election, Labor has made a major pledge – matched by the Coalition the next day – to introduce bulk-billing bonuses for GPs who cover the full cost of adult appointments.
Ken McCroary, a doctor in Campbelltown, said the election spend from both parties was not enough for him to change his billing practices.Credit: Wolter Peeters
These extra payments will start at $21 per visit in the cities and lift to $39 in remote areas, on top of the regular Medicare rebate. They will also boost funding by 12.5 per cent for clinics that bulk-bill everyone.
Kean-Seng Lim, a doctor in Sydney’s Mt Druitt, said the announcement had prompted him to re-evaluate his practices for the first time since he started charging gap fees in 2013. “It’s definitely making us look at bulk-billing for most of our patient consultations again,” he said on Monday.
That’s what the government is aiming for as it targets a 90 per cent bulk-billing rate by 2030, telling Australians they should only need their Medicare card – not their credit card – to get healthcare.
Labor estimates it will lead to a total of 1650 bulk-billing clinics in NSW and 1200 in Victoria, saving Australians hundreds of dollars a year in out-of-pocket expenses as doctors gradually adapt to the changes.
But many doctors are sceptical, saying the incentives are not enough to guarantee free appointments for most Australians, particularly at city GPs used to charging gap fees of $40 or more.
“One of our concerns is that come the date of this announcement, our practices will face hordes of patients expecting to be bulk-billed, no matter where they are,” said Danielle McMullen, president of the Australian Medical Association.
That’s what Steve Szekely, the owner of Trans-Ax Health Care, is worried about. He owns 11 medical centres across Victoria, NSW and the ACT, including two that only bulk-bill in Geelong, and feared this week’s announcements would lead to profound disappointment.
“They put an election spin on this whole thing that people will misunderstand completely, and in the end the medical centres and doctors will be the victims,” he said. “The whole thing is just bad, bad, bad.”
The $8.5 billion policy extends the government’s bulk-billing incentives – previously just for children, pensioners and concession cardholders – to all adults. Labor’s tripling of the incentive for vulnerable patients in 2023 has lifted bulk-billing rates for the first time since they started dipping after the pandemic, by 2 percentage points.
But the choice to bulk-bill – and allow Medicare to cover the full cost of a visit – remains up to GPs.
McMullen said the investment would help clinics that had only recently started charging small gap fees of $10 or $20, because the funding would be enough to reverse that decision.
She said the most likely benefactors would be clinics in rural, regional and disadvantaged areas, which either already bulk-billed or received more government funding.
She warned expectations should be lower in the cities. “In some of our metropolitan centres and in some of our better-off suburbs, the average out-of-pocket cost is now above $40,” she said.
“So the $20 bulk billing incentive still doesn’t come close to meeting those costs.”
It would, however, give GPs extra flexibility to bulk-bill their patients who really couldn’t afford care.
Ken McCroary, a doctor in Campbelltown, said he would need to get patients through the door every six minutes for bulk-billing to be viable. “For me to keep my doors open, I still don’t have any choice but to privately bill,” McCroary said.
Charlotte Hespe, who offers bulk-billing for some patients in the inner Sydney suburb of Glebe, also said it wouldn’t make up for rising overheads and basic expenses.
“It’s a good and much-needed response, but it fails to acknowledge that the rebate being offered doesn’t actually come close to running the consultation in a private setting,” she said.
“This promise for free healthcare for all Australians is a really unfair impost if the government doesn’t actually acknowledge what it would take to fund it. [My clinic] can’t adopt a universal bulk-billing approach, because we take pride in applying high-quality care.”
In the regional NSW town of Armidale, where incentives are slightly higher, doctor Rod Martin expected budgets would remain tight, but clinics would embrace extra funding.
“[They] will need to go back to the books and see whether what’s been proposed will actually keep their practice viable and low-level profitable,” he said. “The trade-off might be, instead of seeing four patients an hour, you have to do one extra consultation to make this viable.”
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