GP Kavya Chaganti explains what Medicare bulk-billing changes mean for you

Dr Kavya Chaganti breaks down the $8.5bn bulk-billing changes promised by both major parties and reveals her main concern for patients.

Last week I was cautiously optimistic when PM Anthony Albanese announced an $8.5bn investment aimed at making primary healthcare more affordable and accessible, ahead of the looming election.

The Coalition has matched this promise – but what are the positives and challenges of this reform and what has prompted it?

There has been a freeze on Medicare rebates GPs receive for many years.

With inflation and the increasing cost of living, this has meant more clinics have moved away from bulk billing.

This combined with the shortage of GPs, particularly in regional and rural areas, has resulted in long wait times for appointments, and increased pressure of practitioners to fit greater numbers of patients into their day.

Dr Kavya Chaganti with her husband Dr Raja Chaganti.

The government’s plan includes expanding bulk billing incentives.

Currently GPs receive an additional payment when they bulk bill children under 16 or people with a Commonwealth Concession Card.

Under the new changes, this will extend to all Medicare-eligible patients from November.

A new Bulk Billing Practice Incentive Program will also offer a 12.5 per cent loading payment on Medicare rebates for GP clinics if they exclusively bulk bill key services including time-based consultations, health assessments, mental health treatment plans and chronic disease management.

Other services such as some procedures will not be subject to the bulk billing requirement.

There is also a plan to train more GPs – an additional 200 per year by 2026, increasing to 400 per year by 2028.

Money will be spent on incentives for junior doctors to specialise in General Practice, along with paid parental and study leave for GP trainees, which they currently do not receive. Addressing GP shortages hopefully translates to shorter wait times for appointments, and better continuity of care.

More bulk billing would mean better access to primary care, the backbone of our health system. Better access means better preventive care, early intervention, less presentations to our already swamped emergency departments, and better health outcomes overall.

For some clinics, these incentives help ease some financial pressure.

In theory, this should help them stay afloat, offer more services, improve facilities, and retain staff. It is estimated around 4800 of over 7000 practices in Australia will be in a better financial position if they adopt universal bulk billing.

While the funding boost is a positive step forward, it is not without concerns.

The incentive structure continues to favour shorter consultations. With higher incentives for shorter consults, we may see ongoing pressure to prioritise quantity over quality.

A standard appointment at most clinics is 10-15 minutes, but my patients don’t just come with one issue.

My day includes everything from childhood health checks to mental health crises, post-natal reviews, menopause consults, wound suturing and chronic disease management.

Good medicine requires time.

Dr Kavya Chaganti is concerned the incentive structure favours shorter consultations.

Time to listen, build trust, educate and improve health literacy. For patients who don’t attend regularly, it’s a chance to also focus on preventive care, mental health, opportunistic skin checks and more.

Some clinics will benefit from this reform, but not all will.

In areas where operational costs are high, bulk billing is not financially viable.

Many people don’t realise most GPs are self-employed; our income depends on what we bill. There’s no paid sick leave, annual leave or parental leave. Let’s not forget the gender pay gap: female GPs tend to earn less because we see more mental health consults and conduct more long consultations, which are reimbursed at a lower rate. GPs and practices still have the autonomy to set their fees as they see fit, so the reform does not guarantee all Australians will have access to bulk-billing.

The announcement included a goal of achieving a 90 per cent bulk billing rate by 2030. Public expectation that “GP visits should now be free” puts immense pressure on clinics.

It also places the onus on us to have the difficult conversations about ongoing underfunding of primary care.

Pressure to bulk bill could potentially lead to reduced services or practice closures.

After years of the Medicare rebate freeze, this reform is a positive step forward.

Although the rebate remains the same, the additional incentives are welcome financial support for those who plan to continue bulk billing.

I hope this reform continues to evolve to support longer consultations, not just short ones.

I hope it evolves to increase rebates to match inflation, and the distribution of funds is equitable across regions. I hope we can look after our patients and our doctors.

Dr Kavya Chaganti is a GP-obstetrician, while her husband Dr Raja Chaganti is a medical oncologist. They are also parents who are based in Sydney and have the popular Instagram @twoaussiedoctors.

Originally published as GP Kavya Chaganti explains what Medicare bulk-billing changes mean for you