A recent analysis by the online health directory Cleanbill indicates an increase in general practitioner (GP) bulk-billing rates across Australia, following federal government incentives introduced last November. The analysis, released this month, reports that the proportion of fully bulk-billing clinics has nearly doubled to 40.2% as of the reporting period, compared to approximately 21% in the prior year. However, the Federal Health Minister has questioned the reliability of Cleanbill's data, offering alternative figures and highlighting ongoing government initiatives. Experts acknowledge the increase but raise concerns about underlying structural issues in general practice and equitable access to care.
Overview of Cleanbill's Findings
Cleanbill's analysis, referred to as the January Blue Report, surveyed approximately 6,900 GP clinics. It found that 40.2% of available practices now fully bulk-bill standard weekday consultations for all adult patients, up from around 20.7-21% at the same time last year. The report identified 1,007 clinics nationwide that transitioned from private or mixed billing to full bulk-billing since early last year.
This reported increase follows the federal government's implementation of an additional 12.5% payment on Medicare benefits for practices that fully bulk-bill all eligible patients for all eligible services. Previously, most bulk-billing incentives were primarily available for children under 16 and Commonwealth concession card holders.
Regional Variations and Out-of-Pocket Costs
The Cleanbill analysis noted regional differences in bulk-billing rates:
- New South Wales: 51.9% of 2,342 clinics reported fully bulk-billing.
- Victoria: 43.6% of 1,793 clinics reported fully bulk-billing.
- Western Australia: 19.8% of 657 contacted clinics reported fully bulk-billing, with 95% stating they were accepting new patients.
- Australian Capital Territory (ACT): Approximately 11.1-12% of 101 responding clinics reported fully bulk-billing. While 96% of GP clinics in the ACT stated they were accepting new patients, the region registered the highest average standard consultation fee at approximately $100.33.
New South Wales and the Northern Territory experienced the most significant increases in the share of bulk-billing clinics, with rates more than doubling.
The report also indicated a 13.5% increase over the past year in out-of-pocket costs for patients who are not bulk-billed, with the national average reaching approximately $49.30. In the ACT and Tasmania, the average total cost for a standard GP consultation now surpasses $100, resulting in average patient out-of-pocket expenses of $58 and $61, respectively. Patients in Canberra have reported difficulties accessing affordable medical care, including choices between essential needs and doctor visits, and challenges in finding bulk-billing clinics, sometimes without adequate transport options.
Government Response and Alternative Data
Federal Health Minister Mark Butler contested the reliability of the Cleanbill analysis, stating that its specific data "cannot be relied upon and should not be reported as accurate." He noted that the analysis did not include clinics that failed to respond to their survey. Cleanbill's report states that clinics unreachable or unwilling to provide information were excluded from pricing and availability calculations if costs could not be independently verified.
Minister Butler provided alternative figures, stating that government data indicates over 3,200 practices are now fully bulk-billing since last November, with almost 1,200 of these having previously operated as mixed-billing practices. He also stated that close to 7,500 general practices are currently registered with MyMedicare since November 1.
The Minister highlighted additional government initiatives aimed at expanding healthcare access, including Medicare urgent care clinics and the 1800Medicare health advice line. The government has also announced plans for further initiatives in specific regions to increase bulk-billing services, including the establishment of three new bulk-billed GP practices in Canberra, with the stated objective of ensuring equitable access to affordable healthcare for all families.
Expert Perspectives on Healthcare Access
Experts have offered varied perspectives on the reported changes and the broader state of general practice.
Dr. Caroline Johnson, a GP and associate professor at the University of Melbourne, described the increase in bulk-billing as "pleasing" to the federal government, suggesting a positive outcome from the government's interventions. She emphasized the importance of affordable healthcare access but cautioned that affordability is only one aspect of overall access, highlighting the need to also consider whether care is acceptable, appropriate, and timely. Dr. Johnson stated it is "too early" to deem the changes a complete success, with patient experience being the true test.
Peter Breadon, health program director at the Grattan Institute, commented that the increase in bulk-billing was anticipated given the new incentives. However, he stated that these changes have not addressed underlying structural issues in general practice, potentially leading to ongoing disparities in care access, particularly for vulnerable patients. Breadon raised concerns that the expanded incentive applies universally rather than prioritizing those with the greatest need, noting that previous incentives were linked to concession card holders or children. He suggested that a different approach to funding general practice is required to target areas with GP shortages and better support clinics serving disadvantaged and low-income patients. Breadon also indicated that more comprehensive Medicare data from the Health Department would provide a more accurate picture than Cleanbill's data, which is based on clinic statements at a specific time.
Michael Wright, president of the Royal Australian College of General Practitioners (RACGP), affirmed that bulk-billing levels remain high, with most GPs continuing to bulk-bill the majority of consultations. However, Dr. Wright raised concerns that Medicare rebates are not keeping pace with the actual cost of care. He cited RACGP data suggesting an increase in the average length and complexity of appointments and called for an increase in Medicare funding, particularly for longer consultations required by patients with complex health conditions.