ausdoc . com . au 14 MARCH 2025

AusDoc explores the impact of the push for universal bulk-billing .

Analysis Paul Smith IT PROBABLY took less than a second — the time needed to subtract $ 25 from $ 45 .

I am talking about the judgement GPs made when they learnt of the $ 8.5 billion investment in general practice to bring back universal bulk-billing for the masses .

The $ 45 figure is ( roughly ) the average gap fee for a standard consult for a non-concessional patient ; the $ 25 the incentive to bulk-bill them instead .

Those exact numbers vary of course depending on geography , but for most of the doctors charging gap fees , the big political promises made to voters are rooted in perverse incentives — an incentive to make a loss .

The fact that Peter Dutton , the betting favourite to become the country ’ s next prime minister , took four hours to commit his own party to the massive spending splurge was alarming .

Even the development of his infamous co-pay policy back in 2014 that

detonated the Abbott Government into oblivion demanded more consideration before his fatal embrace . Voters deserve better . But is there not Department of

Health and Aged Care modelling showing the policy will triple the number of universally bulk-billing clinics — from 1600 to 3200 ? Yes , but it is all top secret . Referring to “ strict legislative obligations ” under section 130 of the Health Insurance Act , First Assistant Secretary Daniel McCabe told Senate estimates the modelling could not be released because it “ contains all of the rebates paid to patients and all of the out-of-pocket costs for every health professional in general practice ”.

How releasing de-identified gap fee data at the level of thousands of de-identified practices identifies anyone seems bizarre .

But no , you cannot see the homework , just take it on trust that it was done and a Federal Government seeking re-election is not simply making self-serving promises about what GPs are going to do .

The absence of transparency here is a failure of the democratic process .

The deeper question is whether the incentives create a new business model to bulk-bill en masse and

This strategy continues to encourage ‘ churn and burn ’ medicine .

— Dr Sally-Anne Parsons

what knock-on effect it will have on patient care .

Is this , as former RACGP president Adjunct Clinical Professor Karen Price was saying , about fuelling a “ churn and

The general practice cash splash

burn ” approach — generating the volume necessary to allow practices to compete with the clinic down the road ?

The big-name corporate offering bulk-billing is ForHealth , which explains why the media opportunities for both the federal Health Minister and the Prime Minister following the policy announcement were held at ForHealth clinics .

It is important to stress the perspective of Andrew Cohen , the company ’ s CEO .

In a world where out-of-pocket costs combined with a doctor shortage deters patients from seeking care , he sees his clinics and their doctors as meeting a fundamental social need .

The phrase he has used in the past is that the company is “ for-profit with a purpose ”, a vision he believes his doctors share , who number over 1000 .

So , is this not just a cash windfall ? In terms of the new incentives , he told Australian Doctor last week : “ First of all , it will keep our bulk-billing practices viable … and it will allow us to actually invest in those practices again .

“ We ’ ve had more than a decade where you were losing money ; there was no investment in basic things like carpet , or painting , or infrastructure . This allows us to invest in practices .”

It will also be important for staffing levels and extended opening hours , he adds .

Mr Cohen , who dislikes what he sees as the “ corporates versus the rest ” narrative , argues that it will allow investment in areas that need bulk-billing access .

“ We haven ’ t really expanded the network for a long time because it wasn ’ t a viable model , so now we ’ ll suddenly be able to say , ‘ There ’ s no bulk-billing in town X — let ’ s go there .” The greatest fear now that Mr Dutton has signed up , is that the policy destroys any prospect of a material rise in Medicare rebates — the reform that the GP groups have demanded since the fall in bulkbilled consults became a political hot potato .

For the current Health Minister , it seems it was never an option .

“[ Some ] doctors have said they would prefer if we just gave this money through an increase to the rebate , with no strings attached ,” Mark Butler told reporters .

“ I understand why some doctors or practice owners might want that .

“ But I couldn ’ t in good conscience do that without guaranteeing a good patient outcome on bulk-billing .”

So , he is saying increasing rebates will result in practices pocketing cash for nothing in return ?

The last words ( for now ) come from Dr Sally-Anne Parsons , a GP in Adelaide who no doubt speaks for many GPs .

“[ Mr Butler ’ s ] conscience about

Minister for Health Mark Butler .

The $ 8.5 billion dollar pledge on general practice made by both the Federal Government and the Opposition has been described as the single biggest investment in Medicare in its 40-year history .

Most of the money will be used to extend bulk-billing incentives to non-concession card holders . It means a metro GP offering a standard bulk-billed consult will receive an extra $ 21.35 , rising to $ 41.10 for GPs in very remote areas . bulk-billing is purely political to promote the line of ‘ free healthcare ’ without delivering the goods .

“ Great for bulk-billing clinics , but why would privately billing doctors reduce their rates to meet this bulk-billing target ?

“ This strategy continues to encourage ‘ churn and burn ’ medicine . What will change for patients ? We desperately need better rebates for long consults .

“ Chronic illness , multiple comorbidities and mental health care need time and continuity of care .”

For now , that seems something that no government , present or future , is willing to pay for .

If you moved to universal bulk-billing , what impact will the changes to the bulk-billing incentives have on your GP income ?

Substantial increase 2 % Moderate increase 7 % Neutral 10 % Moderate decrease 19 % Substantial decrease 59 % Don ’ t know 3 %

AusDoc survey , 27 Feb . n = 923

and pathology .

“ I wouldn ’ t want to be the doctor treating a person I ’ ve never met before , who is showing me their self-diagnosed checklist for ADHD , and saying , ‘ Can I have my prescription ?’

“ That said , I don ’ t think that will be the majority of presentations .

“ The biggest question for all of us is how far along this spectrum do we want to go ?”

‘ I wouldn ’ t want to be the doctor treating a person I ’ ve never met before .’

He points out that experienced doctors remember cycles of particular conditions receiving a surge of attention and treatment .

“ What is different here is that it is a specific syndrome and there is a treatment for it .

“ Ten years from now we ’ ll still be identifying and treating severe ADHD .

“ But I ’ d be very surprised if we ’ re not also saying , ‘ Remember when we got sucked into prescribing stimulant medication for everybody ?’”