New policies will not reverse the trend away from bulk-billing, survey suggests…

Healthed’s latest survey suggests that 31% of GPs have reduced their bulk-billing since August, a significant increase from our previous two surveys, which show that GPs have been steadily trending away from bulk-billing since July 2021.

A further 7% of surveyed doctors said they had already changed their billing model prior to last August, while an additional 9% said they are thinking about it.

Moreover, more than 70% of GPs say that the budget changes will not affect their practice billing model—despite the government’s stated intentions to improve bulk-billing rates.

Less than 5% of GPs say the budget measure will make them more likely to move back to bulk-billing.

Healthed’s survey data suggests that practices that exclusively privately bill were the least likely to change, with 91% saying the new policies would not impact their billing model. A combined 19% of mixed-billing and bulked-billing only GPs said they are now more likely to move away from bulk-billing, while a further 25% said “we were already planning to change our billing model, and we will stick with our plan.”

The survey results highlight the need to have policy that is informed by evidence, says Clinical Associate Professor Pradeep Jayasuriya, who has been outspoken in his concerns over the budget measures.

“It is astounding that a major initiative such as this— trumpeted as the biggest investment in primary care in decades— could be implemented without a fundamental analysis of its impact,” Associate Professor Jayasuriya told Healthed.

“Our professional bodies are not without blame either, as they have been quick to embrace this policy,” he added.

Dr Chris Irwin, who owns two practices in Victoria and heads the Australian Society of General Practice, is also frustrated with the response from the College.

“I’m very, very disappointed with the RACGP for calling this budget a game changer for GPs,” Dr Irwin says.

“All that’s happened is the government is seeing the bulk-billing rate dropping like a stone and trying to ensnare GPs in a bulk-billing cycle, which I don’t think ultimately is a good idea for anyone.”

Dr Irwin says he’s been campaigning for an increase in the bulk-billing incentive—but thinks it should be closer to the AMA or ASGP recommended out-of-pocket of around $50, and much better targeted to people who are “truly vulnerable”. He cites the example of a pensioner couple with multi-million dollar assets who are still eligible for bulk-billing.

“Both sides of government have lied to patients for the last 20 years, saying they’re adequately funding general practice. And over the last 20 years, the Medicare rebates have halved in real terms,” Dr Irwin says.

“So someone has to be honest at some point, if people want general practice to exist, either the Government has to double their investment in general practice in real terms, or patients have to pick up the bill,” he says.

He also believes the budget measures will negatively impact privately billing GPs, with the cuts to the 723 MBS item number for team care arrangements, for example.

About 28% of GPs in Healthed’s survey said the changes will improve their practice viability—while 58% said the budget measures would have no impact, and 14% said their practice would actually be worse off.

Credits

Survey conception and design – Dr Ramesh Manocha, Yasmin Clarke, Lynnette Hoffman

Survey analysis and visualisation – Yasmin Clarke

Writing and reporting – Lynnette Hoffman