The Royal Australian College of GPs has led the argument that access to bulk billing is falling across Australia and is now well short of both the 88 per cent claimed by the previous government and the 82 per cent figure released by the health department last week.
On Thursday, Health Minister Mark Butler said the former government’s 88 per cent figure was reached by “selectively quoting” bulk billing. Butler said he had asked his department for more information “to obtain a more complete and accurate picture”.
Stephen Duckett, a health economist and University of Melbourne honorary professor, is concerned too much is being made of the decline in bulk billing, which he says has fallen around 1 to 2 per cent in the last six months.
“Whether it continues that decline, we don’t know yet,” says Duckett, a former federal Health Department secretary who is now part of the Albanese government’s Medicare taskforce, which will report by the end of the year.
Duckett says there could be a case for additional funding for GPs, who the Australian Bureau of Statistics found in 2021 had an average weekly salary before tax of $3300, or about $172,000 a year.
But he also says that increasing rebates for GPs is not the only way money can be found to help maintain Medicare. “You might decide to give other payments; to nurses to reduce their waiting times, things like that. It’s quite a complex issue.”
The Royal Australian College of General Practitioners says just 64 per cent of trips to the GP were bulk billed, according to its 2021 Health of the Nation report into general practice billing methods. For those GPs who charge a fee on top of the Medicare rebate, the average out-of-pocket cost for patients was about $39. The report also found that a third of doctors planned to increase those fees in 2022.
A survey by the college of its GP members last week found a quarter of those who did not currently charge their patients plan to introduce a co-payment in the future.
College president Karen Price says unless greater investment in general practice is made, “more and more practices will have little choice but to pass the cost on to patients or close their doors”.
For Hopkins, had those costs been passed on when he started seeing his GP, Dr Paul MacCartney, at a Fitzroy community health centre, the “dark path” he was on could have led to a far darker place.
“I guess he saved my life. He reassured me over and over again that things would be okay eventually,” Hopkins says.
For the past five years, psychological conditions, including sleep disturbance and depression, have been the most commonly reported reasons for GP visits. And mental health visits are increasing.
Hopkins spent years visiting MacCartney and today considers himself on top of the issues that dogged him for years. “I still suffer, but I’ve learned to manage,” he says .
The 60-year-old says when he started seeing MacCartney, there was no way he could have afforded even a $10 or $20 “gap fee” to see a GP.
Born in East Gippsland, Hopkins worked as a nurse in hospitals, psychiatric homes and aged care. He quit nursing about a decade ago as he struggled with depression and anxiety. Today, he says his part-time “lollipop man” job – a primary school crossing supervisor – is far more relaxed.
Hopkins says if he had been forced to shop around for a doctor that bulk billed, he simply would have stopped going.