Is the 'largest investment in Medicare in 40 years' enough?

In an election year, Medicare bulk billing has become a hot topic. But is an increase in bulk billing rates likely to make it more affordable to visit your doctor?

It's a sure sign we're heading to the polls when both sides of politics preface policy promises with the words "If we are elected...".

And so it begins with Medicare funding.

The Albanese government has pledged to "make the single largest investment in Medicare in 40 years" by expanding bulk billing incentives for general practitioners (GPs).

The idea is that by 2030, nine out of 10 GP visits will be free (bulk billed), up from around 78% at present.

The Coalition has pledged to invest $9 billion into Medicare.

So, who will benefit?

The answer may not be Australians seeking medical help.

What's happening with Medicare?

GPs can decide how much they charge patients - either bulk billing, in which case doctors accept the fixed Medicare rebate as full payment for the service, or setting their own, higher fee, which patients pay from their own pocket.

The problem is that fewer GPs are bulk billing.

After hitting a pre-COVID high of 86%, bulk billing rates have declined to about 77% of practices nationally. This varies widely though. In the ACT only half of GPs bulk bill.

The drop-off, according to Dr Michael Wright, president of the Royal Australian College of GPs, is that "Today's patient rebates don't come close to the cost of care."

Why is bulk billing declining?

Under Medicare, a GP is currently paid $42.85 for each 20-minute consultation.

It's a meagre rate of pay. My own GP - a dedicated bulk biller - happily chats with patients without any sign of clock-watching.

Yet she employs a receptionist, an office manager and a nurse to keep the practice ticking over. Moreover, the surgery is well-equipped with a pricey-looking range of medical technology.

It adds up to a great service. But it's hard to see how this doctor makes much of a profit earning around $120 an hour (assuming she can cram three 20-minute consultations into every working hour).

Will increased bulk billing rebates make a difference?

Labor's proposed uptick in bulk billing rates should see a metro-based GP earn $69.56 for a half-hour appointment, up from $42.85 at present.

In rural areas, where it can be hard to attract GPs, a standard consultation will see a doctor earn up to $86.91

Good on paper, but is it enough?

Maybe not.

Dr Wright says Labor's $8.5 billion Medicare package is welcome, but adds, "Extending bulk billing incentives to everyone won't necessarily mean everyone gets bulk billed, because patient rebates are still too low to cover the cost of care."

Dr Danielle McMullen, president of the Australian Medical Association, agrees that, "With our ageing population and growing chronic disease rates, GP consultation items have become out-of-date."

She believes the GP consultation item structure has failed to keep up with the growing complexity of care that patients need, and is "biased towards shorter consultations at a time when patients need to spend longer with their GPs".

Doctors need to take care of their own financial health

It's not just about patient care.

The reality is that GPs are running a small business. If they can't make a profit, there isn't much incentive to stick around.

The bottom line is that despite the spin, there is no guarantee either Labor or the Coalition's Medicare funding policies will see more Australians pay less to visit their GP at a time when doctors are facing rising costs and increased patient demands.

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