Seeing a doctor for ‘free’ is just not honest, GPs explain

After weeks of hearing Anthony Albanese’s mantra that a Medicare card is “all you should need to see a doctor for free in Australia … not your credit card”, as he holds the ubiquitous piece of green plastic, a range of general practitioners has stepped in to bring much-needed realism to the debate. After the Prime Minister’s pledge to spend $8.5bn to provide bulk billing for 90 per cent of patients – courtesy of taxpayers – “tonnes more GP clinics that bulk-bill every patient”, Peter Dutton, eager to head off a Labor Mediscare campaign, rushed in to outdo it, promising $9bn. Neither leader outlined spending offsets or revenue increases to pay for it. It appears to be added to the nation’s credit card bill. That early tit-for-tat bidding war for buying votes, unfortunately, set the tone for a high-spending, low-rent campaign that is not serving the public interest at a time when living standards and productivity are falling. The challenges posed by deficits, debt and the need for economic reform are being glossed over – a mistake that will cost Australians dearly in future.

For all the bluster about the extravagant campaign centrepiece, GPs on the frontline of the issue warn that many patients will continue to face gap fees. As AMA president Danielle McMullen says, people should not expect to walk into a GP clinic and be seen for free. And many in the medical profession are concerned that politically driven policies will create an incentive for doctors to offer fast consultations, out of step with many patients’ needs for comprehensive care as the chronic disease burden of our ageing population rises. Health editor Natasha Robinson reports that informal surveys of more than 2500 GPs, and feedback to major doctors’ organisations, indicate that only a small minority of extra practices are likely to become fully bulk-billing clinics. From November, under Labor’s promised Bulk Billing Practice Incentive Program, the incentive for doctors to bulk-bill every Australian would triple – if GPs use it. But many GPs say they will not be in a position to sign up. Doing so would represent a pay cut and make their practices unviable, they insist. In practices that bulk-billed all patients, the triple incentive payments would lift the total Medicare payment from $42.85 to $69.56 for a standard short consultation, rising to $86.91 in the most remote areas. But the incentive does not rise commensurate with the length of a consultation, discouraging doctors in full bulk-billing practices from conducting longer appointments.

In the real world, many customers pay less for GP gap payments than for hairdressing, spa treatments, home cleaning, mechanics, dentistry, legal advice, personal training, bookkeeping, car detailing, veterinary appointments and children’s coaching. For that reason, many voters recognise the idea of free GP appointments regardless of patients’ income is incongruous, despite it being adopted as holy writ by both sides of politics. Medicine is not free, nor is the cost of running a clinic. Limiting the scope of funding for GPs to short consultations, more affordable for taxpayers, could short-change patients. It could also ultimately cost them more, necessitating more visits to specialists, whose out-of-pocket fees are often several times higher than GPs’ gap payments.

The idea of seeing a GP for free is “just not honest’’, as Melbourne GP Karen Price told The Australian. Medicine is a profession, not a shop, she said. “This is sort of just putting everyone in a very poor position for the sake of a political vote, because they think it’s a winner, and they’re using health as a political pawn … we need serious reform.”