Bulk Billing, So Far Away, By Mrs. Vera West

It is hard for poor Australians to find medical practices which offer full bulk billing with no out-of-pocket expenses. Doctors can no longer do it even if they want because of rising costs. However, if the government wanted to help it could, as shown by a recent analysis at The Conversation.com. And it would not be too expensive either. But this government is not interested, and thinks that it is better to let Aussies just get sick and die out. I call it economic-demographic euthanasia.

To illustrate this, the present system with Medicare requires a full payment to be made then the Medicare reimbursement is made. That assumes that one has the full payment in one's bank account. It is not possible to simply pay the gap in cash, it has to be one as one transaction, and this is required by law. I have seen people complain about this on TV. A friend wrote to the Health Minister, and other pollies, saying that there could be a simple legislative change to allow this dual payment, but not interested. He only got one reply from a Liberal, nothing from the independents and One Nation, I am sorry to say. If they will not make a simple change to one Act, and my friend drafted the change, then we will not expect the Albo government to do anything substantial over bulk billing.

As far as health goes, most of us are on our own.

https://theconversation.com/australia-can-afford-to-bulk-bill-all-gp-visits-so-why-dont-we-230204

"Being able to afford health care is a pressing issue for many Australians. And encouraging GPs to bulk bill is one measure the government is taking to ease the strain.

So what would it take for GPs to bulk bill everyone? In our recent paper, we calculated this is possible and affordable, given the current health budget.

But we show recent incentives for GPs to bulk bill aren't enough to get us there.

Instead, we need to adjust health policies to increase bulk-billing rates and to make our health system more sustainable.

How do the incentives work?

In recent years, the government has introduced various incentives to try and encourage GPs to bulk bill (so patients pay nothing out-of-pocket).

The most recent has been the "triple bulk-billing incentives" or "triple bonus" for short. These have been in place since November 2023.

Under these incentives, GPs in metropolitan areas are paid a A$20.65 bonus if they bulk bill concession card holders or children under 16 years. GPs in rural and remote areas are paid $31.35-$39.65 extra. These bonus payments are in addition to regular Medicare rebates GPs receive.

But when we looked at whether these latest incentives are likely to work to boost bulk billing, we found a city-country divide.

City GPs may not be convinced

We worked out the triple bonus will not help most people in metropolitan areas.

That's because in these areas the bonus is much lower than what patients currently pay out-of-pocket. In other words, if GPs did bulk bill these groups, their income would be lower than what they could have charged. So the bonus wouldn't be enough incentive for them to bulk bill.

For example, we found in greater Melbourne, the average out-of-pocket costs for a non-bulk billed GP visit is about $30-$56 depending on the suburb. This is much higher than the $20.65 triple bonus amount in metropolitan regions. We see similar patterns across all metropolitan areas.

But country GPs may be swayed

The picture is different in rural and remote areas. Here, the average out-of-pocket cost for a non-bulk billed GP visit varies substantially – around $28-52 in rural regions and $32-123 in remote areas. The highest cost on the mainland was $79 but GP visits on Lord Howe Island were the most expensive overall, at $123.

For patients living in areas where their actual payment is less than the bonus amount, the incentive does help. In other words, it would be financially advantageous for GPs to bulk bill these patients, but not where the out-of-pocket costs are higher than the bonus.

Our online map shows where GPs are most likely to bulk bill. The map below shows how out-of-pocket costs vary around Australia.

How about bulk billing for all?

The picture is a little more complex when we start talking about bulk billing all GP visits – regardless of location or patients' concession card status.

We worked out this would cost about $950 million a year for all GP services, or $700 million a year for face-to-face GP consultations.

This is within reach under the current budget, especially for face-to-face GP consultations.

The government has earmarked $3.5 billion over five years for the "triple bonus" incentives. That's $700 million a year.