The federal government claims bulk-billing rates are on the rise, but is it being less than honest about the figures?
In a press release, health minister Greg Hunt claimed the bulk-billing rate across all Medicare services had reached a record high of 83.5 per cent in the December quarter to 2021, an increase of 6.5 per cent since 2012–13. He also claimed GP bulk-billing rates were sitting at 88.4 per cent for the quarter to December 2021.
“This means almost nine out of 10 visits to the GP over the 2021 calendar year were provided with no out-of-pocket costs for the patient.”
However, in an investigation by The Guardian, closer examination revealed that the 88 per cent figure covered the number of services provided by a GP, not the number of patients who were bulk-billed.
The Guardian also claimed some medical practices were getting around the issue by separately billing the gap amount and, as a result, covering up out-of-pocket costs.
The Royal Australian College of General Practitioners (RACGP) said the figures were further inflated by the fact that concession card holders must be bulk-billed and often had multiple health conditions, and there was mandatory bulk-billing for telehealth in the first quarter of 2020–21.
The RACGP’s Health of a Nation 2021 report claimed the number of patients who had all their services bulk-billed for 2018–19 was only 64 per cent and that only about one in five GPs worked at a practice that bulk-billed all their patients.
The group said part of the problem was that the rebate had not been kept up with inflation, estimating that average health inflation rates were about 3 per cent and the indexation was set at 0.9 per cent in 2021.
Medicare funds a rebate of $39.10 per standard consultation, a figure that has not changed since 2013, apart from indexation rises.
“The growing gap between the federal government’s contribution and the cost of general practice care and the cost of providing care is affecting the sustainability of the out-of-pocket cost for patients,” the RACGP stated in the report.
It said the issue was also having a concerning impact on the appeal of working as a GP, because graduates were naturally attracted to more lucrative specialties.
RACGP president Dr Karen Price said it was time to increase the remuneration for GPs including the Medicare rebate. Dr Price said Medicare billing arrangements were one of the most pressing concerns for members.
“If the federal government is serious about boosting the general practice workforce … so all patients can access high quality primary care, it is vital this is reflected in long-term funding arrangements.”
According to one researcher, some overbilling might not be deliberate.
Synapse Medical Services founder Dr Margaret Faux, a solicitor who studied medical billing for her thesis, found the payments system was a “morass of labyrinthine law that has become largely inaccessible and incomprehensible”.
Dr Faux said this led to medical practitioners demonstrating a low level of legal literacy and often leaving the billing to third parties, many of whom “may be significant contributors to non-compliance”.
“Without reform, the government can expect no improvement in … out-of-pocket costs for patients.”
However, Dr Faux also told The Guardian that bulk-billing statistics were “essentially rubbish”.
Neither major party has made any policy announcements on increasing the rebate during the election campaign.
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