A major consideration for some people is whether or not a medical practice bulk-bills. As a patient, bulk-billing is great — you pay nothing upfront, and you don’t have to go to the trouble of claiming fees back from Medicare. The problem is that it’s not always available.
- Figures from Medicare indicate that around 75% of all GP services are bulk-billed. But while practices often bulk-bill concession cardholders, many charge other patients privately.
- A recent survey of GPs found that just 28.7% bulk-billed Medicare for all patients and 20% bulk-billed for pensioner/Commonwealth concession cardholders only.
The reason for this, according to the AMA, is that GPs can no longer afford to bulk-bill all their patients. When Medicare first began many GPs bulk-billed because rebates were close to the cost of providing the service, but the AMA says this is no longer the case. The estimated cost of providing a standard (Level B) consultation is $55 but the rebate is just $31.45.
Length of consultation
It’s also been argued that charging fees allows GPs to spend more time with each patient. The length of the consultation with your doctor is important, with longer consultations associated with higher patient satisfaction and increased likelihood of preventive care, among other benefits. And there’s a concern that where practices do mainly bulk-bill, GPs may find themselves under pressure to see more patients more quickly to remain viable. However, in reality there’s no published evidence suggesting you’ll receive a shorter consultation if you’re bulk-billed than if you’re privately billed.
That said, financial incentives under the current Medicare Benefit Schedule (MBS) structure certainly don’t favour long consultations. For example, the rebate for a Level B consultation item, which can be up to 20 minutes long, is the same whether the consultation finishes after six minutes or 20 minutes, with the greatest per-minute financial return obviously being for six-minute consultations. Given that the average consultation length is 15 minutes, there’s little financial incentive for GPs to bulk-bill and it’s not surprising that some prefer to bill privately.
A report to the Federal Government in 2003 proposed a change to this MBS structure, but there’s been no action on this to date. Apart from some additional incentives to bulk-bill specific groups, including Commonwealth concession cardholders and children under 16, the situation remains the same.
CHOICE thinks everyone should have access to bulk-billing services, and wants disincentives that face bulk-billing GPs to be removed.