More than 40 percent of Victorian GPs bulk bill, but at what cost?

Victorians are now twice as likely to find a bulk billing GP compared to last year, according to the newest annual report from online healthcare directory Cleanbill. 

But as GP clinics struggle to balance their bottom lines, is enough being done to ensure a high quality of care?

What is “bulk billing”? Bulk billing is a service provided by some GP clinics where all charges are put through Medicare, which reduces the out-of-pocket payment required from the person attending the GP clinic.

More free visits: Published on Monday, Cleanbill’s fourth annual Blue Report highlighted that 701 – or 43.6 percent – of Victorian GP clinics said they offered bulk billing to all clients – more than double of last year’s figure of 302.

How we got here: Launching in 2022, Cleanbill is an independent healthcare directory. Its work involves researchers phoning and surveying every GP clinic in the country on their billing practices. The latest “Blue Report” covers the period from November 1 to mid-December.

Are federal incentives enough? In November, the Federal Government introduced subsidies for clinics that bulk bill every patient.

Bulk billing clinics are eligible to earn an extra 12.5 percent on the current Medicare rebate paid by the government, while clinics in more remote locations receive more – up to about 190% of the Medicare subsidy received by metropolitan GP clinics.

Long term uptake: Cleanbill founder and chief executive, James Gillespie, said it was uncertain how many would continue to use the new incentives in the long term.

🗣️“Often, clinics would advise us that…they're only doing it for six to 12 months to determine what the effect will be on their bottom line and they may yet switch back if the effect isn't what they want to see,” Gillespie told the Eastern Melburnian.

The problem with relying on bulk billing: Dr Malcolm McKelvie is a GP at Yarragon Medical Centre and told the Monitor his practice hasn’t changed its bulk billing policy since the new legislation came in. 

• Yarragon Medical Centre still offers bulk billing to pensioners, under 16s and other patients at the discretion of the doctor.

McKelvie said he was concerned the increase in bulk billing doesn’t address the disparity between Medicare rebates and rising inflation that has occurred over the last 20 to 30 years.

• 🗣️ “Medicare rebates haven't followed inflation,” he said. “If incomes don't keep up with inflation, then we'll just be back in the same awful position that everyone was in when there was a fight to increase the amount of private billing.”

According to the Australian Medical Association, this disparity between Medicare rebates and inflation is leading to higher out-of-pocket costs for patients as they face an increasing gap between the actual fee charged by doctors and the amount the Medicare rebate covers.

Costs on the rise: According to the report, the average cost for people visiting GPs in Victoria was $48.18 – a 14.7 percent jump compared to the average charge of $42.01 the year prior.

Gillespie said this was increasing because GP clinics that do not bulk bill have seen little to no change to their bottom line.

“As a result, a lot of those GP clinics have continued to increase their out-of-pocket costs,” said Gillespie.

Minister’s rebuttal: Federal Health Minister Mark Butler told the Guardian Cleanbill’s data “cannot be relied upon and should not be reported as accurate”, citing the fact they did not include clinics which did not respond to the survey.

Responding to these claims, Gillespie said he believed people could rely on Cleanbill’s data because it was publicly available.

• 🗣️ “They're able to verify it themselves by going on the Cleanbill directory,” Gillespie said.