Massive shift in health system as bulk billing declines

A major change has been reported at GP clinics across the Gold Coast, with dire implications for the health system. Here’s what’s happening.

THIS columnist recently noticed a small but not insignificant change at his local GP clinic.

Nothing has been altered about the service provided, which has always been excellent.

But there is a new twist: No longer can patients wander out the door with a friendly wave goodbye when their consultation has been completed, as has been the case since the clinic first opened many years ago.

Instead, since November, it has been necessary to stop and pay a $10 fee for a short consult, or $20 for a long one.

Now $10 is not much, and your columnist is not about to cry poor for having to pay it.

In fact, for a private billing practice, it’s an extremely small out-of-pocket cost.

But it was a reminder of a hugely significant shift in our health service – one that has been repeated at clinics across the Gold Coast in recent months, and indeed across Australia as a whole.

A survey of 4188 GP clinics by healthcare directory Cleanbill between August and December last year found only 42.7 per cent were bulk billing.

Doctors across the Gold Coast are increasingly moving away from bulk billing.

The survey found the rate in the Greater Brisbane area to be only 29.8 per cent, with the average out-of-pocket cost pegged at $38.62.

It’s hard to over-estimate the significance of this change, as CleanBill founder James Gillespie succinctly pointed out.

“When we lose bulk billing among the majority of GPs then we lose universal healthcare,” he said.

The impact of the change is felt not just at the primary care level, but throughout the health system.

If people struggling with the rising cost of living are discouraged from visiting their GP because of the cost when experiencing minor symptoms, they risk ending up in hospital in a considerably worse condition.

They may even find themselves at a point where they call an ambulance to get there. On a visit to Gold Coast University Hospital recently, Gaven MP and Environment Minister Meaghan Scanlon said she was concerned that impact was already being seen.

“I think the reduction in the number of GPs offering bulk billing is adding pressure to our hospitals,” Ms Scanlon said.

“I know in my electorate I looked recently and the amount of GPs that do provide that service has reduced.

“People who are doing it tough, it’s impacting on their decision to go and get primary healthcare.

“That then exacerbates situations and then that person may end up in our emergency departments.”

Minister for Health and Aged Care Mark Butler. Picture: NCA NewsWire / Brenton Edwards

The reason for the reduction in GPs offering bulk billing is extremely simple: while costs have escalated for clinics, the Medicare rebate for a short consultation has barely budged, rising just over $4 in ten years (from $35.60 to $39.75).

“Medicare rebates simply have not kept pace with the cost of providing high-quality patient care,” Royal Australian College of GPs (RACGP) President Dr Nicole Higgins said.

“As a result, practices are under strain, and many are making the difficult but necessary decision to stop bulk billing some or all of their patients and move to a private or mixed billing model.”

Dr Higgins said the RACGP wanted the Federal government to “lift Medicare patient rebates to a level that actually reflects the practicalities of providing care amidst rising costs and an ageing population.”

While the problem was clearly caused by previous administrations, it is coming to a head on the Albanese government’s watch. It has already pledged $750 million to help reform Medicare, to be spent according to the recommendations of a task-force due to report in the coming weeks.

But Federal Health Minister Mark Butler, asked last week about increasing the rebate, was quick to hose down expectations.

“What I want to do is be very clear with people: this is not easy, it’s not going to be quick,” he said.

“And our government is not simply going to be adding more money to the existing system.

“We’re about delivering a better, more modern system.”

What that means, and whether it will do anything to ease the pressure on GPs, remains to be seen.

In the meantime, expect bulk billing to be offered by ever fewer Gold Coast GPs.

Originally published as Massive shift in health system as bulk billing declines