The federal government has come under fire from doctors for its decision to make changes to more than 900 items on the Medicare Benefits Schedule (MBS).
The impact of these changes, which came into effect on July 1 after a five-year MBS review, remains to be seen.
Health Minister Greg Hunt has sought to defend the government’s record, arguing that more Australians were being bulk-billed by their GP than under Labor.
On June 6, he told reporters:
“That has seen 88.7 per cent of people year-to-date receive their GP services for free. That is 6.7 per cent higher than when we came to government.”
Is he correct? RMIT ABC Fact Check investigates.
Mr Hunt’s claim is over-egged.
The share of patients who are bulk billed may be rising. However, Mr Hunt’s numbers relate to the proportion of GP services that were bulk billed, not patients.
Patient numbers would be lower, as people may receive multiple medical services during a single visit, with only some being fully subsidised by the government.
As one expert explained, bulk-billing is used more frequently by particular groups, so the rate for services could increase without necessarily benefiting additional people.
Medicare data for the first nine months of each financial year show that between March 2013 and March 2021, the bulk-billing rate for services increased from 82.0 per cent to 88.7 per cent.
This equates to a rise of 8.2 per cent, or 6.7 percentage points.
While there is limited public data for the number of people who are bulk billed, there is some material available on the share of patients who were entirely bulk billed by their GP.
This rate has also been rising, although the available data runs only to 2018-19.
According to health department numbers, it grew by 5.2 percentage points, or 8.5 per cent, over roughly six years of Coalition government, to reach 66.3 per cent of patients in 2018-19.
Mr Hunt attributed the increase in services to Coalition policies, and there was indeed a surge in bulk-billing after the government introduced telehealth items to the MBS as part of its response to the pandemic.
However, it’s less clear what credit the government can take for the years prior to 2020.
Under the Coalition, the bulk-billed services rate grew by progressively smaller amounts in every year from 2014. Between 2015 and 2019, the same can be said for the share of fully bulk-billed patients.
Experts consulted by Fact Check pointed to the government’s Medicare rebate freeze as a key reason for the slowdown in growth.
Context of the claim
During his doorstop interview, Mr Hunt said: “… we have seen record numbers of bulk billing, which means that more people than ever as a percentage of the population are able to attend the doctor for free.
“That has seen 88.7 per cent of people year-to-date receive their GP services for free. That is 6.7 per cent higher than when we came to government. So 6.7 per cent higher than in 2012-13, for the first nine months of that financial year.”
Soon after, on June 15, he told Parliament the government had achieved “a 6.7 per cent increase in terms of those who can visit the doctor without having to pay”.
He also said that “we’ve gone from 82 per cent of patients paying nothing to visit the GP under Labor to 88.7 per cent under us”.
Mr Hunt referred specifically to people who received “GP services”.
So while specialists and other doctors can also opt to bulk bill, Fact Check has limited its analysis to rates for general practitioners.
The official data
The federal Department of Health publishes figures on bulk billing as part of its quarterly Medicare statistics.
Its bulk-billing rates reflect bulk-billed services as a percentage of total medical services (i.e. bulk- and patient-billed).
Margaret Faux, a lawyer specialising in health insurance law who recently completed a PhD on the subject of Medicare compliance, told Fact Check that the government’s bulk-billing statistics lacked transparency and were not comprehensive.
“Medical practitioners could be charging unlawful gaps for every bulk billed encounter and the government would not know because those transactions are recorded on separate software systems,” an extract from her thesis reads.
The Coalition’s record
Medicare figures for GP services (or “GP non-referred attendances”) are available as quarterly, financial year and rolling 12-month time series.
The department also publishes figures for the part of the financial year to date.
At the time of Mr Hunt’s claim, the most recent figures available were for March 2021.
During his interview, Mr Hunt said he had compared “year to date” figures with the “first nine months” of the 2012-13 financial year.
This comparison excludes several months of the last Labor government, as the Coalition “came to government” in September 2013.
For the sake of completeness, Fact Check has also assessed the Coalition’s record using data for the 12 months to September 2013 and March 2021, though the difference is not significant.
What the numbers show
Mr Hunt said the bulk-billing rate had risen to 88.7 per cent under the Coalition, up from 82 per cent under Labor.
Indeed, these figures are consistent with a chart published by the department showing the bulk-billing rate for GP visits over the nine months to March 2021 and March 2013.
This equates to a rise of 8.2 per cent, or 6.7 percentage points.
For the 12 months to March 2021, the rate stood slightly higher at 89.7 per cent.
That compares with 82.5 per cent for the year to September 2013, when the Coalition was elected.
So across the government’s roughly seven and a half years, the rate increased by 8.7 per cent, or 7.2 percentage points.
What does that say about patients?
Mr Hunt claimed that nearly 90 per cent of people “receive their GP services for free”.
However, as Fact Check has written before, the government’s Medicare statistics relate to the number of services that are bulk billed, not the number of patients.
Fact Check: Bulk billing
The Royal Australian College of General Practitioners (RACGP) explained in its 2020 Health of the Nation report: “Patients may receive a number of services during a single visit to a GP, with some of these services bulk billed and others privately billed.”
The only people who do not pay to visit the doctor in a given period are those who are entirely bulk billed.
Data provided by the Department of Health to the Senate in October 2019 showed that the share of patients who were entirely bulk billed by their GP was typically 30 per cent (20 percentage points) lower than the rate for services.
The rate was 61.1 per cent in 2012-13, Labor’s last full year in office, and increased in each of the Coalition’s first six years, to reach 66.3 per cent in 2018-19.
This represents an increase of 8.5 per cent under the Coalition, or 5.2 percentage points.
GPs were initially required to bulk bill for any telehealth consults.
From April to December 2020, this rule continued to apply for concession card holders, under-16s and patients more vulnerable to COVID-19.
Susan Mendez, a research fellow at the University of Melbourne’s Institute of Applied Economic and Social Research, told Fact Check the telehealth changes had pushed up the rate of bulk bill services.
“There was a massive increase in telephone consultations and these were all bulk billed,” she said.
“That would have increased the bulk-billing rates for non-referred attendances.”
Notably, the Medicare data shows that until the pandemic hit, the bulk-billing rate for services had been growing more slowly every year since 2014, shortly after the Coalition was elected.
The department’s data reveals a similar trend in the rate for fully bulk-billed patients starting from 2015.
In the year to June 2019, the rate for bulk-billed services grew by a paltry 0.1 per cent, while the rate for patients grew by 0.3 per cent.
In its 2020 report, the RACGP also highlighted slowing growth in bulk-billed services, noting that in recent years some states had seen the rate of fully bulk-billed patients go backwards.
Professor Van Gool said bulk-billing rates were the result of supply and demand for GP services, as well as government policy.
And with so many potential influences in play – including, for example, wages growth or workforce changes – it was “virtually impossible to isolate any single factor”, he said.
However, Professor Van Gool suggested the Medicare rebate freeze “would have put downward pressure” on bulk-billing rates.
The freeze, which suspended annual increases to the Medicare rebate, was a short-term measure adopted by the previous Labor government but reintroduced and extended for several years under the Coalition.
Fact Check: GP costs
On the other side of the ledger, he said, some regions would have benefited from changes to the government’s bulk-billing incentive at the start of 2020, though to a far lesser extent.
Dr Mendez similarly said it was difficult to give a definitive answer on what was driving growth in bulk billing prior to the pandemic, but also highlighted the significance of growing demand for medical services, particularly among older Australians.
She told Fact Check that the pre-pandemic slowdown “can be related to the introduction of the MBS fee freeze”.
Principal researchers: David Campbell and Sonam Thomas
- AMA, Media release, June 6, 2021
- Department of Health, Medicare Benefits Schedule (MBS) Review, July 2, 2021
- Greg Hunt, Doorstop interview, June 6, 2021
- Parliament of Australia, Hansard, June 15, 2021
- Parliamentary Library, Medicare: A quick guide, July 12, 2016
- RACGP, Medicare and bulk billing, accessed June 2021
- Services Australia, Bulk billing, September 7, 2020
- Department of Health, Statistics under Medicare, June 8, 2021
- Fact Check: Health Minister Greg Hunt said the bulk-billing rate is up …, April 9, 2019
- RACGP, Health of the nation, 2020
- Department of Health Documents prepared in response to correspondence from Senator O’Neill …, October 10, 2019
- AIHW, Patients’ out-of-pocket spending on Medicare services, 2016-17; August 16, 2018
- Department of Health, MBS changes fact sheet: COVID-19 Temporary MBS Telehealth Services, July 1, 2021
- RACGP, Fact sheet: COVID-19 telehealth MBS items, July 2, 2021
- Department of Health, Providing healthcare remotely during COVID-19, May 20, 2021
- Department of Health, Bulk billing incentives, December 2019
- Anthony Scott, ANZ-Melbourne Institute health sector report: The impact of COVID-19 on GPs and non-GP specialists, 2020
- Anthony Scott, ANZ-Melbourne Institute health sector report: General practice trends, 2017
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