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GPs ditching bulk billing as costs rise and Medicare rebates lag, survey shows

Medicare card in a wallet
The Royal Australian College of General Practitioners says Medicare rebates for GP consultations have not kept pace with the cost of providing care. Photograph: Dave Hunt/AAP

Doctors are increasingly scrapping bulk billing, according to a survey of almost 500 GPs, with stalling Medicare rebates and the costs of running a practice cited as key reasons.

HealthEd, a private professional education company for doctors, surveyed 477 GPs on 2 August and found more than one in five – 22% – had recently changed their billing model.

Of those that changed their billing, 33% moved from bulk billing to mixed billing, and 67% changed from mixed billing to private billing. Rising costs was the reason for the switch given by 77% of GPs, while 17% cited Medicare cuts and 6% attributed the change to Covid-related costs.

When more than 1,000 GPs were asked the same survey question last year, just 10% said they had recently changed their billing model. The proportion of GPs considering changing has also increased, the surveys show.

Practices making the switch include a Sydney clinic that this month sent a message to patients saying “unfortunately we are no longer able to bulk bill” from 1 September. “All patients, even those with a pension or health care card, will be required to pay a fee for their consultation,” the message said.

A “super clinic” with more than 100 practices across Australia sent an email earlier this year saying it was switching to private billing from 1 July. “We will continue to bulk bill all pension, concession card holders and children 15 and under,” it said. The clinic did not answer questions from Guardian Australia about why billing was changing.

The Royal Australian College of General Practitioners (RACGP) said Medicare rebates for GP consultations have not kept pace with the cost of providing high-quality care.

The impact of the rebate freeze from 2013 to 2019 is still being keenly felt, the college said, and while Medicare rebates for most GP appointments did rise on 1 July this year, it was only by 1.6%, far short of the most recent inflation figure of 6.1%.

Dr Karen Price, president of the RACGP, said the federal government could boost investment in GP care to ease the pressure on practices and ensure vulnerable patients aren’t left behind.

“We are calling for a 10% increase to Medicare rebates for consultations lasting 20 to 40 minutes and 40 minutes plus, as well as a new Medicare item for consults lasting more than hour,” Price said.

“This will have a lasting impact on the health and wellbeing of people who need to have multiple health conditions carefully managed and result in fewer patients ending up in a hospital bed with a problem that could and should have been managed by their GP.”

The chief executive of the Consumers Health Forum, Leanne Wells, said: “We are increasingly hearing consumers report that gap payments for Medicare services are increasing beyond what they could afford, and bulk billing GPs were becoming increasingly difficult to find.”

She said while the CHF is “sympathetic” to an increase in Medicare rebates, which would help general practices struggling under the current levels to resume bulk billing, at least for those on lower incomes or in difficult circumstances, “we are concerned that there is some evidence that a rebate increase might also be inflationary”.

“CHF wants to see more sweeping reform to primary care involving funding reforms that shift the system away from fee-for-service ‘six minute’ medicine to open up better access to a comprehensive set of services in general practice in addition to those provided by GPs such as pharmacists, nurses, dieticians and social workers,” she said.

The health minister, Mark Butler, has acknowledged that finding a bulk-billing doctor is “harder than ever”.

“Primary care is in its worst shape since Medicare began,” he told Guardian Australia on Tuesday. “Across the country we hear stories of Australians not being able to get in to see a bulk-billing doctor or GPs changing from bulk billing to mixed billing.”

He said the government was committed to investing in general practice and strengthening Medicare with almost $1bn of investment.

This includes funding for the strengthening Medicare taskforce – which will identify ways to boost affordability, improve access and deliver better support for patients with ongoing and chronic illness – and a $750m strengthening Medicare fund.

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