GP costs are affecting more Australians than a few years ago. There’s been a lot of talk about a bulk billing crisis, with many people reporting that they can’t see a doctor without paying an out-of-pocket fee.
But the biggest, most pressing problem arises in the communities where most people pay fees, the so-called bulk-billing “deserts.” These deserts are more likely to be in poorer areas, so the people who need bulk billing most are missing out.
While Medicare funding changes are needed to address this problem, we also need to look at more innovative solutions. One option is for the federal and state governments to do this get in and support or set up clinics where doctors, nurses and other health professionals work.
Bulk billing is down, but from an all-time high
The proportion of patients that never paid GP reimbursement fell from 67% in 2020-21 to 64% in 2021-22. But those rates are still high by recent standards. The rate has only fallen back to 2015 levels and remains much higher than a decade ago.
Yes, it’s disturbing to see bulk billing going down, especially when rates have gone up a lot. Patients who are not billed in bulk are now paying average A$45 out of pocket when they visit a GP. This is a 20% increase in real terms over the last ten years.
But while the nationwide trend is worrying, it masks a much bigger problem.
Big inequality
In some parts of Australia, for example the voters from Chiefly, Fowler and Werriwa in Sydney’s outer west – more than nine in ten GP patients are always bulk billed.
But in other parts – for example, the voters of Canberra and Franklin and Clark in southern Tasmania – that number is less than four in ten.
Unlike the total bulk billing rate, these huge differences have been around for many years: the problem was just as bad a decade ago.
Bulk-billed deserts wouldn’t be such a problem if they were only in the wealthiest parts of Australia, as fees are less likely to prevent wealthy people from getting the care they need. But there are deserts in much poorer areas that bill massively.
Compared to all but the wealthiest areas, the bottom fifth of voters by income have the lowest bulk billing rates. In 13 of the lowest-income voters, less than 60% of patients are bulk billed.
Rural areas are also worse off: 60% of patients in rural areas are always bulk billed, compared to nearly 69% in metropolitan areas.
The bulk billing deserts in the poorer parts of Australia represent a serious failure of the system. National approx 3.5% of people say they skip GP care because of cost, with higher rates in rural and poorer areas. Those numbers will be much higher in bulk-billed deserts, putting many people’s health at risk.
What the government should do
There have been to call to action to pour billions of dollars into increasing the Medicare rebate and bulk billing incentives.
But while the government must ensure that payments to GPs cover their costs, that does not solve the problem of mass billing.
It could help halt the decline of bulk billing nationally, and in some areas where bulk billing is low. But the money will mainly flow to high-billed areas – it won’t help much to provide more care where there is far too little.
Read more: GP practices are struggling. Here are 5 lessons from abroad to reform the finance system
Bulk billing deserts are an ongoing problem that requires new solutions. To reverse them, the government needs to address two of the structural problems they cause: unified funding for GPs and areas that don’t have enough health care to make ends meet.
The government already has signaled it will develop a new financing model that pays GPs for providing ongoing care, which would be an improvement on the current outdated and dysfunctional system. That funding should yield higher payments for patients with greater needs.
That would increase revenues for clinics with patients most in need of free care, freeing those clinics from having to charge their patients. It would be a big step in the right direction.
Funding reform will help clinics avoid overcharging patients.
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But even then, there would still be areas without enough health workers to meet the needs of the community, including many rural areas, leading to a lack of care, and too little bulk billing. Governments need to go far beyond the Medicare rebate and other incentives to fix these broken healthcare “markets.”
The federal and state governments must get in to support existing clinics or establish new ones that employ paid health professionals. This support should be tailored to local needs. This may involve hiring a GP from a rural hospital when there are no GPs in the area, or setting up a new community-controlled primary careor help an existing clinic hire additional staff.
Rather than ad hoc announcements, there should be some national funding for this concern, targeting the areas of greatest need – especially the poorest deserts with bulk billing.
This change should be accompanied by many other reforms to attract clinicians to areas where they are most needed, such as further expanding new models from general practitioner employment opportunities And course in the countryside, whichnational generalistdoctors a single employer during their training in a range of different health settings in a region.
Reforms are also needed to expand the teams that support GPs in low-care areas. This could reduce GP burnout, enable clinics to provide more care and bring Australia in line with other countries. In addition to administrative, allied health, pharmacist and other roles, some teams could include this doctor’s assistantswho work under the supervision of a doctor and can provide all the services that a doctor provides.
A test for next month’s federal budget is whether it will fund solutions to bulk-billing deserts — an enduring injustice in our healthcare system.
Read more: Medicare reform is off to a promising start. Now comes the hard part
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