Anthony Albanese has announced $8.5 billion in new Medicare spending, with a goal of making 90% of all GP visits free. But nobody seems to know what’s going on with bulk billing, Zacharias Szumer reports.
If you’re anything like me, you’re somewhat surprised by the federal health department reporting that over 77% of visits to Australian GPs are bulk-billed.
For your correspondent – admittedly in passable physical and financial health – this figure seems very high when considering the palpable dissipation of bulk billing over the last 15 years.
The non-concession-card bulk-billing rate of 20.7% cited in Cleanbill’s most recent report, feels more intuitively correct – but perhaps that’s just because I’ve been fortunate enough to not need a low-income card for the last several years.
Just over a month ago, I tried to make sense of these various bulk-billing prognoses – an exercise that’s about as pleasurable as getting a skin graft without anaesthesia.
Well, call me a sucker for punishment, but there were some unanswered questions that seemed to justify closer examination from me and the team and West and Co. clinics.
So, flatten your tongues and say ‘ahhh’ please – we’re going in for another look.
Finally served by the Butler
As we discussed during our last ‘appointment’, Health Minister Mark Butler seems to have adopted a stock phrase about bulk-billing either being in “free-fall” under the Coalition or having been “put into free-fall” by them.
While MWM certainly isn’t arguing that the Coalition did much for our ailing public health system, bulk-billing certainly wasn’t in “free fall” during their decade-long grip on federal power, as an AAP fact-check from May 2024 showed.
When AAP asked Butler about the claim, one of his spokespeople pointed to “a different measure of bulk-billing”. Our noble national newswire didn’t say what this measure was – probably because it was told to them ‘on background’.
Your correspondent pressed the minister’s office about what this measure was but didn’t receive a response before submitting the previous story.
But here at MWM, we don’t like to just let the news cycle move on, and our politicians wiggle off the hook – so the pestering continued.
Finally, after several weeks of repeated emails and calls, one of Butler’s media people passed on a few links to help us get a grasp on where the health minister was coming from.
The main piece of supporting evidence was this August 2022 article in which then-Royal Australian College of General Practitioners (RACGP) president adjunct Karen Price said bulk-billing rates were in “free fall”. However, her statement was a reaction to data from the Primary Care Business Council (PCBC), a lobby group representing the seven largest general practice operators in Australia.
The PCBC’s survey of their members found bulk-billing rates closer to 61%, a 12% decline from two years beforehand.
Anyway, long story short, it’s somewhat disingenuous for Butler to be cribbing lines from the RACGP when their president’s statement was made in response to totally different data. This would be doubly true if more recent data from PCBC doesn’t paint such a heroic picture of Labor pulling bulk-billing back from a Coalition-induced death spiral.
MWM reached out to the PCBC and asked if there was a more up-to-date survey the group could pass on, but they said they couldn’t help us there.
Bulk-billing has increased from 76.5% a year ago, but only for people under-16 and over 64 – not surprising given that Labor’s tripling of the bulk-billing incentive in September 2023 only applied to concession-card holders and under-16s. Data source: Health Department Medicare dashboard.
Are the figures skewed?
In the same article, Price also said the PCBC figures provided evidence that bulk-billing rates were “not what they seem”.
In 2022, the bulk-billing rate was a whopping 88% – a figure partly buoyed by mandates to bulk-bill COVID-19 vaccinations and certain telehealth consults related to the pandemic, Price said.
While these factors may no longer be relevant, she cited another reason that might explain why the government stats might seem higher than many Australians’ anecdotal experiences would suggest: “The figures are skewed because there are some patients with multiple, complex issues who see their GP again and again for different types of health problems.”
Most Australians see a GP six or seven times per year, but for people over 80, the average is “over 17 per year”, RACGP’s sitting President Michael Wright said. When seeing these frequent visitors, GPs are likely using their discretion to bulk bill more of their visits.
This pushes up the health department bulk-billing rates because this is measured not per person but per visit.
If we look at bulk-billing rates on a per-person basis – as the Productivity Commission does – then the number dramatically declines.
The commission reported in early February that the proportion of Australians who had all their GP visits bulk-billed had fallen from 51.7 per cent in 2022–23 to 47.7 per cent in 2023–24.
It’s important to emphasise that this number looks particularly dismal because it’s only counting people who had every single GP visit bulk-billed in that year.
Both the health department and the commission’s ways of measuring bulk billing are valid,
it’s just that one makes the government look a lot better than the other.
So don’t be surprised that health ministers only like to reference one of these numbers when trying to score political points.
Unfortunately for them, election results are also counted on a per-person basis, so the commission’s rate is probably something they should be concerned about, too.
https://staging.michaelwest.com.au/medicare-the-winner-as-parties-match-funding-pledges/
Zacharias Szumer is a freelance writer from Melbourne. In addition to Michael West Media, he has written for The Monthly, Overland, Jacobin, The Quietus, The South China Morning Post and other outlets.
He was also responsible for our War Power Reforms series.