Medicare rebate, bulk-billing the election issues being ignored?

The Australian Medical Association recommends doctors charge $86 for a standard consultation. The Medicare rebate is less than half that amount, $39.10, and that is incensing both patients and GPs and putting pressure on hospital emergency departments.

Add in the fact that more practices are reducing their bulk-billing services in a bid to be sustainable and there are fears for the health of Australians with limited income.

Out-of-pocket expenses are crippling for many older Australians and anyone with chronic illness, yet the option of attending a bulk-billing practice is becoming increasingly difficult.

GPs say bulk-billing and the Medicare rebate is sending them broke and hospital emergency departments are reporting a spike in attendances by patients who cannot afford to see a GP.

It’s a situation that must be addressed by the next government, says the Royal Australian College of General Practitioners (RACGP).

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RACGP president Dr Karen Price says poor pay means just 15 per cent of medical graduates now want to practise as GPs, down from 50 per cent in the past. This is putting pressure on doctors’ availability, especially in regional areas that are experiencing a growth spurt as more people move from the city and embrace working-from-home freedoms.

Doctors working as hospital registrars need to take a $60,000 a year pay cut to switch to general practice while electricians and plumbers charge more – $45 to $50 for 15 minutes work – than a GP earns, a News Limited report maintains.

A Sydney practice manager says young doctors are refusing to work at bulk-billing practices because the pay is so low they struggle to pay off their $100,000 HECS debt.

GPs across the country say they are either heavily reducing or phasing out bulk-billing.

“We’re having to have the conversation with a lot of our patients and say we can’t continue to bulk bill,” says one doctor.

“It’s becoming very hard to run a business and earn money,” says another.

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The government says it has the highest GP billing rates in history at 88.7 per cent but the RACGP says that figure is inflated because GPs, by law, have to bulk bill COVID jabs and initially had to bulk bill telehealth consultations during lockdowns.

A spokesperson for retiring health minister Greg Hunt says Medicare rebates “are already indexed annually and will continue to be”.

“Bulk billing rates are 6.6 per cent higher under the Coalition than under Labor,” he says.

Opposition health spokesman Mark Butler says “it’s never been harder or more expensive to see a GP”.

“By freezing the Medicare rebate for six long years, [Prime Minister] Scott Morrison ripped billions of dollars from general practice, causing gap fees to skyrocket,” he says.

“We’ve already announced our Medicare urgent care clinics, which will make it easier and cheaper to see a doctor when your family needs it.”

Read: Medicare must be revamped given weight of COVID, say GPs

A Senate inquiry into rural health services recommended an increase to Medicare rebates and more incentives to encourage doctors to move to regional areas.

“The attractiveness to move into general practice anywhere has been reduced because the Medicare rebates have been held back by successive governments,” says Dr Michael Clements, chair of the rural faculty of the RACGP.

He says both Liberal and Labor governments had been slowly “withdrawing money” from primary healthcare and fears the interim Senate report’s recommendations will be left forgotten by both major parties ahead of the federal election.

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Written by Janelle Ward

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