Melbourne’s low bulk billing rate revealed as GP warns it will decrease ‘exponentially’

A top doctor has warned the number of bulk-billing GP clinics in Melbourne is dipping toward a “critical threshold”.

Less than 40 per cent of Melbourne doctors’ clinics bulk bill all their patients, sparking fears people are missing out on care as more GPs start to slug patients’ extra fees.

The data, from a survey of more than 4000 Australian clinics, comes amid debate on the state of the healthcare system and Medicare, with doctors long warning the rebates’ failure to keep pace with inflation threatens bulk billing’s ­viability.

The Blue Report, from online healthcare directory Cleanbill, revealed only 39 per cent of Greater Melbourne general practitioners clinics bulk bill – meaning they do not charge any fees above the Medicare rebate – all patients.

The average out of pocket fee for a standard GP appointment in Melbourne was more than $40, though in Port Melbourne this figure climbed to more than $60.

Cleanbill founder James Gillespie said it “calls into question” whether Australians truly have a universal healthcare system.

“Forty dollars … it’s a concerningly high amount,” Mr Gillespie said.

“The Medicare rebate index­ation rate has not kept up with inflation, so practices have often had to raise their costs in order to make ends meet.

“From anecdotal evidence, it would indicate that there are fewer bulk billing practices now than there were.

Less than 40 per cent of Melbourne doctors’ clinics bulk bill all their patients.

“Practices … are saying … we’re not going to charge you at the moment, but in a couple of months, we will charge you.”

He said fees could cause people to skip appointments – and miss check-ups – or attend crowded emergency rooms, a problem he said was hap­pening “more and more ­frequently”.

The profession’s peak body said the number of bulk-billing general practitioners would continue to decrease “exponentially” and warned Australia was heading for a “critical threshold”.

Royal Australian College of General Practitioners president Dr Nicole Higgins said it was “financially unsustainable” for clinics to charge the same price as the Medicare rebate.

“The rates of bulk billing will continue to decrease and we’re now hitting a critical threshold where I expect that they will decrease exponentially,” she said.

“It’s like asking your plumber or hairdresser to take a 50 per cent discount on what they do.

“More practices are closing, more practices are in financial difficulty and also with the threat of payroll tax on the horizon.

“You can’t keep the doors open if you bulk bill.”

She said bulk-billing was only affordable if clinics saw a high number of patients in a short amount of time – an incentive that decreased the quality of care.

“Unfortunately, what it rewards is high throughput medicine, versus the way GPs want to work, which is those longer consultations and it’s also the way patients expect to be treated,” she said.

“As we’re seeing more and more complex care and especially mental health, there is that need for long consultations.”

Dr Higgins said GPs can no longer afford to subsidise patient care and criticised the Federal Government for focusing funding on hospitals, which bear the consequences of poor primary care investment.

“Now we’re getting flow-on effects into our hospital system,” she said.

“We’re seeing increased ramping, increased waiting times and the budgets are blowing out.

“The federal government has been pouring more and more money into the state hospital systems, instead of investing at the grassroots in general practice.”

She called on the government to “urgently” triple the Medicare bulk billing incentive for vulnerable patients, increase the longer consultation rebate and increase the number of GPs.

“By 2032, there’s expected to be a shortfall of 11,500 GPs in Australia unless we make change,” she said.

Melbourne’s bulk billing rate of 39 per cent in the Blue Report was far lower than the 83.4 per cent figure touted by the government and released last quarter, which measures the percentage of GP appointments and services that were bulk billed as opposed to which clinics only bulk bill.

At the time, the Royal Australian College of General Practitioners said the data ­underplayed the problem and warned the drop (it had fallen by 3.6 percentage points) would continue.

The college had previously warned federal bulk billing figures were inflated by items such as Covid vaccine appointments and revealed almost one-in-two GPs surveyed said it was financially unsustainable to continue practising.

Federal Health Minister Mark Butler said this week that primary care was in “its worst shape since Medicare began” after “nine years of cuts and neglect”.

“The former government was not honest with Australians about the true state of bulk billing in Australia by ­selectively quoting figures,” Mr Butler said.

“I have asked for more ­information from my ­department.”

The Blue Report also found more than one in 10 clinics in Greater Melbourne was not open to new patients and the average out-of-pocket fee varied greatly between suburbs.

The most expensive suburbs – after Port Melbourne – were Hawthorn, Beaumaris, Prahran and Clifton Hill, where the average gap was in the low $50s, while Doreen had the lowest at $24.45.

Regional Victorian clinics were not analysed by the ­dataset.

Greater Melbourne average: $40.05

Melbourne’s highest average gap fees

1. Port Melbourne $60.25

2. Hawthorn $52.18

3. Beaumaris $51.25

4. Prahran $51.22

5. Clifton Hill $50.92

Melbourne’s lowest average gap fees

1. Doreen $24.25

2. Craigieburn $24.38

3. Thomastown $24.50

4. Mernda $25.75

5. Vermont $28.25

Originally published as Melbourne’s low bulk billing rate revealed as GP warns it will decrease ‘exponentially’