Bulk billing has its drawbacks

Anthony Albanese’s pitch to voters, as he flashed his Medicare card, that “all you should need to see a doctor for free in Australia is your Medicare card … not your credit card” was highly effective, helping deliver Labor’s landslide win. It was a cornerstone of Labor’s health policy, but it is no surprise, as Sarah Ison revealed on Tuesday, that nearly a quarter of doctors’ clinics are unlikely to take up the bulk-billing incentive.

Three weeks before the election we reported that the Australian Association of Practice Management, the peak professional body that supports effective administration in thousands of GP surgeries, described the proposal as “smoke and mirrors”.

Now, as Labor’s 94 MPs take their seats in the House of Representatives, spilling over to the opposition side, Health Minister Mark Butler’s top bureaucrats warn that the sweeteners being offered by Labor for doctors and practices to join the amended bulk-bill incentive program are not enough to encourage almost one in four practices to do so.

“There is a risk the percentage of the 12.5 per cent incentive split between practices and providers is not considered a sufficient incentive for practices or providers to join the program,” the public service brief to Mr Butler states. “Some patients will still face out-of-pocket costs.”

That will not surprise patients who recognise that healthcare is not free and that someone, patients or taxpayers, has to pay. The government has promised the “single largest investment in Medicare” on ­record, delivering 18 million more bulk-billed GP visits a year via $8.5bn in funding.

Its stated aim is to lift bulk-billing rates to 90 per cent by 2030 through an increase in the Medicare payment to doctors from $42.85 to an expected $70 for appointments lasting 20 minutes or less. On Tuesday, the Australian Medical Association said while a significant pool of federal funding for the primary health sector was welcome, the funds should have been used in a different way than was being proposed. AMA vice-president Julian Rait said the bulk-billing system encouraged short, sharp consultations that were not in the interest of patients.

In the event that the government’s aim is not met, it will have two options: to further increase the incentive for GPs to participate in bulk billing, or rely on a greater user-pays component. Across time, greater reliance on user-pays for those able to pay, provided the most disadvantaged patients are looked after, would help relieve spending pressures and free up funds as treatments become better and more expensive.

Australia’s health system is one of the world’s best, but the idea that primary care can be “free” for most people, regardless of income, is not necessarily in patients’ best interests.