Why Geelong GPs are shifting from bulk-billing

Doctors are increasingly turning away from bulk-billing and passing rising costs on to patients. See the map of clinics in Geelong where you won’t get charged.

Rising costs and low rebates are pushing general practitioners to move away from bulk-billing, causing patients hip-pocket pain.

Grovedale’s Kim Kee battles numerous health problems including multiple sclerosis, osteoporosis, asthma and mental health issues.

The 45-year-old said MS caused “a lot of invisible symptoms daily”.

She said she had been bulk-billed by her GP clinic since she started going there about eight years ago — but this had recently stopped.

Kim Kee is speaking out about struggles accessing bulk billing and medical costs. Picture: Mike Dugdale

Ms Kee said she was apprehensive to change clinics as the practice knew her so well.

She said, as a pensioner, she now paid at least $15 out-of-pocket per GP appointment, whereas bulk-billing previously meant it was free.

“It’s quite a lot of money for me because I go so often,” she said.

Ms Kee is studying and said she had struggled to maintain employment due to her health problems.

She said changes to bulk-billing were “awful”.

“It’s really hard,” she said.

“Sometimes you get the weeks you get all your bills … it’s just too much.”

On top of regular GP visits she has to fork out for specialists, and also pay medical bills for her son who has a disability.

Western Victoria Primary Health Network chief executive Rowena Clift said it was aware of several Geelong region general practices transitioning away from bulk-billing to mixed-billing or private billing models over the past few years.

She said this was primarily due to the rising costs of delivering care and low Medicare rebates.

“General practices are finding it increasingly challenging to deliver high quality primary care as bulk billing fees have not kept up with inflation, rising costs of staff wages, medical supplies, insurance and utilities,” Ms Clift said.

“Unfortunately, moving to mixed-billing results in patients having to pay a gap fee.”

She said the federal government had established a Medicare task force to identify the highest reform priorities in primary care focused on affordability and quality of care.

Geelong’s bulk-billing rate for ‘GP non-referred attendances’ – services that are typically claimed by GPs and do not require a referral — was 84.9 per cent in 2021-22, down from 86.1 per cent in 2020-21, data provided by the federal health department showed.

Last financial year Geelong’s rate was lower than Victoria’s (88.6 per cent).

Providers were required to bulk-bill temporary telehealth items added to the Medicare Benefits Schedule between March 2020 and September 2020 and GPs are required to bulk bill Covid vaccine support items.

A health department spokesperson said GPs and their practices operated as private businesses and were free to determine the value of their service, including whether they bulk-billed some or all of their patients, or charged a co-payment.

“Doctors are able to and encouraged to consider the personal circumstances of their patients when determining the fees they charge, and many do so, deciding to alter their fees based on the circumstances of individual patients,” the spokesperson said.

“To encourage GPs to bulk-bill patients who may find it more difficult to meet the costs of medical services, the government provides a bulk billing incentive for bulk billed services provided to Commonwealth Concession Card holders and children under 16.”

Royal Australian College of General Practitioners Victoria deputy chairman Bernard Shiu said many universal bulk billing clinics — which bulk-bill all patients — were considering moving away from that mode of practice.

GP Bernard Shiu

“The Medicare rebate is not survivable,” he said.

Dr Shiu said patients should be able to access care.

The Newcomb GP is the owner of Banksia Medical Centre.

He said when he took over seven years ago it was still bulk-billing “quite a lot” of patients.

Patients that used to be bulk-billed – concession and health care card holders – pay less than the normal fee now, he said.

Banksia Medical Centre provides bulk billing on weekdays for eligible Medicare card holders – DVA Gold card holders and children 15 and under.

Dr Shiu said the clinic had begun to bulk bill less clients as he wanted to provide more time-consuming preventive care and the previous structure would not have provided enough funding.

The model helped the clinic provide allied health as well, he said.

Originally published as Why Geelong GPs are shifting from bulk-billing