Medicare bulk-billing needs to be sustainable

Concerns about falling rates of bulk-billing for doctor visits raise difficult health, budgetary and political challenges. In coming years, that will be exacerbated by the health needs of our ageing population and an increase in the proportion of retirees, many of whom rely on bulk-billing. Health Minister Mark Butler has ordered his department to analyse what he believes is “skewed” Medicare data that claims the national bulk-billing rate is 88 per cent. Doctors have labelled that figure “complete garbage” and produced their own records that suggest the true rate may be almost 30 per cent lower. People living in some of the most disadvantaged parts of the country are finding it hardest to access bulk-billing clinics. That has prompted local councils in Tasmania to take the extraordinary step of funding primary care for residents.

Mr Butler is particularly concerned at reports some pensioners are being charged gap fees. That would be a serious problem for many and would add to pressures on public hospitals’ casualty departments. The Australian College for Emergency Medicine has warned emergency departments are “dangerously overloaded” because, over a long-term period, many people are presenting who can’t access or afford medical care in the community.

The financial struggles of some GPs is concerning many in the profession. The problem is discouraging medical graduates from pursuing careers in general practice. As reported on Monday, many GP clinics have begun writing to their patients advising they would no longer bulk-bill, prompting doctors’ groups to warn universal bulk-billing is on the brink of collapse. Last week, Royal Australian College of General Practitioners president Adjunct Professor Karen Price said Medicare rebates for GP consultations had not kept pace with the cost of providing high-quality care. The full impact of the rebate freeze from 2013 to 2019 was still being felt. “While Medicare patient rebates increased on 1 July this year; it was only by a miserly 1.6 per cent, which equates to 65c for a standard consult,’’ Dr Price said. “When you consider the most recent inflation figure of 6.1 per cent and the enormous costs practices are shouldering while managing patients during a pandemic, you can see what we are up against.’’ Only 16 per cent of medical students were considering general practice. And the uneven distribution of GPs disproportionately affected rural and remote areas. Without proper investment this would worsen, Dr Price said.

As Mr Butler examines the full picture on bulk-billing, and seeks solutions, the government, at a time of rising prices and fiscal stringency as the budget recovers from Covid-19, needs to ensure the system remains viable. Healthcare is never free; someone has to pay. And costs are rising as treatments become more sophisticated. Compared to the US and Britain, Australia has an excellent system, blending universal healthcare with private services and insurance. The question needs to be asked: Is it time to consider an element of user-pays for doctor visits for patients who can afford to make a contribution? That is already the case for many patients in many practices, and anecdotal evidence suggests the trend is increasing. A carefully devised, means-tested co-payment system could help make bulk-billing sustainable for pensioners and other financially disadvantaged patients.

The Abbott government suffered a major backlash from the public, the medical profession and its backbench when it tried to introduce a $7 Medicare co-contribution in the May 2014 budget. The measure was canned later that year. It would still be unpopular and Labor, which prides itself on founding Medicare, might never consider it. But it is now the Albanese government’s responsibility to make the system work.