Out-of-pocket costs rising despite bulk-billing adoption for GPs nationwide

Having survived payroll tax changes, the cost-of-living crisis and the decline of bulk-billing, GPs warn they will need more funding to stay afloat.

RACGP President Nicole Higgins has praised the progress of Australia’s primary care sector, but appealed for its continued federal funding. Picture: NCA NewsWire / Martin Ollman

With the general practice sector recovering from a year of “fragmented” support, GP s are pleading for further federal investment in order to prevent their patients spilling into overloaded hospitals.

Ahead of the release of its Health of the Nation report, the Royal Australian College of GPs found patient out-of-pocket costs had risen from $34.91 on average for a 20-minute consult in 2023, to $36.86 in 2024.

RACGP President Nicole Higgins argued GPs were still handing on rising costs to their patients, signalling continual issues in the sector despite a rise in investment in the last federal budget, and reforms to bulk billing.

The survey of 3000 GPs indicated 25 per cent were able to bulk bill more patients since the institution of MyMedicare, which tripled the incentive payments provided to clinics who bulk billed.

Through 2023 and into 2024, Australia’s primary care sector grappled with a continuing decline in bulk-billing rates, a cost-of-living crisis that tanked an industry composed mainly of small businesses, and changes to payroll taxation which threatened some clinics with retrospective bills as high as $800,000.

In 2023, a ruling by the NSW Court of Appeal threw the exemption of GPs from payroll taxes into question. The change held practitioners to the same standards as larger corporate practices, presenting costs that prior RACGP surveying indicated only 3 per cent of GPs could absorb.

Independent GP practitioners have since been offered exemptions across all states and territories on retrospective payroll taxes.

Dr Higgins called for the expansion of primary care funding in Australia to 10 per cent of the federal health budget, in line with the UK.

“When Medicare was first designed 40 years ago, it covered 85 per cent (of the price) of the consultation with the doctor … now in general practice, it covers less than 45 to 50 per cent of the cost of consultation,” she said.

“Now we’ve had ten years of lack of investment in general practice and primary care by successive governments until the last budget.

“What the last budget shows is that funding gets results, and if you put money into those targeted areas, you can change the outcomes. That’s what’s happened, especially in our rural and regional areas, where those (bulk-billing rates) have increased.”

She argued MyMedicare was still “immature” with the prior rise in primary care funding a “first step to rebuild Medicare”.

Dr Higgins also petitioned for a 20 per cent increase to all Medicare rebates for 20-minute and longer consults, with additional increases for rural and remote communities.

The Australian Healthcare Index reported 42 per cent of Australians have begun to see GPs less because of the out-of-pocket costs. It was the most cited challenge to accessing healthcare for patients nationwide.

“Prevention is better than a cure, and we need to, as a country, think about how we fund our healthcare system,” Dr Higgins said.

“We are at a juncture where we have a choice. Do we put more money into general practice and primary care, or do we just pour more and more money into expensive, shiny hospitals?”

On Sunday the RACGP also urged the state governments to commit to complete exemptions for GPs from payroll tax, following an election pledge by Queensland’s Liberal National Party to do so.