Gap fees for patients could be halved with Medicare rebate lift

The GP College is pushing for a major lift in the Medicare rebate for long consultations to halve out-of-pocket costs.

Denise Sivasubramaniam has chronic health problems and like millions of other Australians struggles to afford to see her preferred GP

Gap fees for long GP appointments could be halved and millions more appointments made available if the next federal government gave a substantial lift to Medicare rebates.

The nation’s GPs College is pushing for a 40 per cent lift in the depressed Medicare rebate for consults lasting longer than 20 minutes in a bid to arrest the trend of patients struggling with the cost of living and experiencing chronic disease delaying seeing a doctor. Modelling indicates the plan would halve out-of-pocket costs from an average of $59 to $25, and lift the national bulk-billing rate to 85 per cent.

The proposal forms the centrepiece of the Royal Australian College of General Practitioners’ federal election platform, which is centred on accessible, ­affordable general practice care for all patients. A major focus is also a proposal to lift Medicare rebates for mental health consultations by 25 per cent, creating an additional 370,000 appointments.

The RACGP election pitch has costed a 40 per cent Medicare rebate lift for long consultations at between $734.6m and $1.04bn a year, depending on demand. It would save Australians $215.7m in out-of-pocket costs and prevent 3885 emergency department presentations and 11,227 hospitalisations, saving the health system $63.3m a year.

“We know from statistics that more and more people are putting off seeing the GP because of cost, and that’s getting worse in this cost-of-living crisis,” said RACGP president Michael Wright. “That’s why we need major investment in patient rebates so that patients can see a GP when they need to, because no one should be putting off having to make a choice between seeing their GP and paying for their groceries.”

Royal Australian College of GPs president Michael Wright is calling for a lift to Medicare rebates. Picture: Max Mason-Hubers

The college is also asking for the $3.5bn bulk-billing incentive policy introduced by the Albanese government two years ago to continue as Health Minister Mark Butler released new figures showing the investment had resulted in an additional six million bulk-billed GP visits between ­November 2023 and December 2024, lifting the national bulk-billing rate by almost 2 per cent to 77.5 per cent.

The initiative triples the remuneration from the government to GPs who bulk-bill ­patients on concession cards, as well as pensioners and children.

“As a government, we urgently moved to protect bulk billing for those who need to see their GP most often: pensioners, concession cardholders, and families with kids and young teenagers,” Mr Butler said. “Our investments are making a meaningful difference, but we know we need to do more to strengthen Medicare.”

One of the patients who has benefited from the bulk-billing incentive is 42-year-old Sydney woman Denise Sivasubramaniam, who has only been able to work a limited amount since suffering a stroke. Although the policy has helped with medical costs, she says it has meant that she is not able to always see her preferred GP for her complex medical problems, because not all GPs will bulk bill.

“When you are an incredibly complex case, you need someone who is an expert in your needs,” she said. “But those GP tend to charge out of pocket because the rebates aren’t high enough. So I was left seeing a GP who … had the best of intentions and tried their best for me, but was just not the correct fit.”

Ms Sivasubramaniam said that a lift to Medicare rebates for all patients who needed long consultations for complex medical needs was necessary.

“It’s not a good long-term strategy to not invest in Medicare,” she said. “It creates a bigger problem, because people just get more and more unwell. If it’s the choice between groceries and going to see the doctor, I know a lot of people who will just suffer through and their health problems get bigger.”

The RACGP is also calling for strategies to make women’s health more affordable, better subsidised iron deficiency treatments, and changes to remuneration and benefits to those training to be GPs.