GPs warn bulk billing system is on brink of collapse
- Replies 14
General practitioners, our first point of contact for medical concerns, have a grim outlook on the future of Australian healthcare. Without government support and sufficient Medicare funding, our bulk billing system may crash.
Bruce Willett, vice-president of the Royal Australian College of GPs, has been a medical doctor for decades. In recent years, his practice was put in a tough position after Medicare failed to fill the gaps caused by rising operational costs.
‘We're really concerned for our patients and have tried hard to keep up bulk-billing to support those patients to obtain the health they need,’ the GP said to ABC News.
But many doctors can no longer afford to - a recent HealthEd survey found that more than one in five GPs decided to change their billing model.
Many blame the situation on the Medicare funding freeze. Introduced in 2013, it was meant to be a temporary savings measure but has been in place since.
The Labor government increased the rebate by 1.6 per cent last month. However, Dr Willett said it is insufficient to make up for their losses, especially with Australia’s 6.1 per cent inflation rate.
Instead, Australian GPs are pushing for a hike of 10 per cent, especially for consultations that take longer. Willett said: ‘The way that Medicare is structured at the moment, unfortunately, it tends to favour shorter consultations, and we're seeing increasing levels of mental illness, increasing levels of multiple chronic illnesses, and that just takes time to work through.’
Aussies took it to social news website Reddit to react.
One user said: ‘I don't feel like we have an accessible and universal healthcare system anymore, and that is a terrible slippery slope for us to be on.’
Another sympathised with the impossible situation the doctors are in: ‘I discovered not long ago that complex wound care costs GPs money, even their normal gap barely covers the cost. I wonder how many things GPs do that they are losing money on due to supply costs and lack of medicare rebates.’
A Redditor lamented: ‘This wave of inflation will no doubt kill off all remaining bulk billing GPs given the fee rebates won't increase anywhere near inflation. It seems to be kicking off a cycle of practices going to private.’
Marie Healy, based in Redfern, is another GP who chose to stop bulk-billing after two decades of service.
In an opinion piece in The Sydney Morning Herald, she said: ‘Medicare rebates have historically undervalued our service, but the freeze several years ago compounded this. I earn at least 10 per cent less than I did six years ago. I worked at a small practice that had been operating in Redfern for more than 30 years. It closed six years ago because of this. That GP and I moved to a larger practice, which decided this year to abandon bulk-billing for all but the neediest and First Nations patients.’
Healy continued: ‘The practice takes a proportion of all our earnings to pay for nurses, receptionists, equipment and the usual running costs. In the end, it’s a matter of survival.’
Doctors say that the current billing system is unsustainable and would lead to surging fees for consultation. Credit: Karolina Grabowska
The Redfern physician says that she always has bulk-billed pensioners, but now they have to pay $20 out of pocket. In her practice, she noticed that those who could not afford the consultations were the happiest to pay.
‘Although I am concerned that fees might be a disincentive for people to access healthcare, my experience to date has been that it frequently comes down to choice, and how much people value their health and the care their GP provides,’ Healy wrote, ‘I’ve had many instances of patients insisting I bulk-bill them when they smoke a pack a day, or regularly see a naturopath, or pay hundreds to vets, or spend thousands on overseas trips or fancy dining. For some reason, they demand a discount from the GP but not the others.’
Primary care is integral to healthcare. About 85 per cent of Australians see a GP at least once a year, but Healy notes that GPs seem to be undervalued in the country. ‘There is ample evidence that primary care, delivered by GPs, helps to keep people well, improves life expectancy, and reduces the burden on hospitals, yet billions have been directed away from primary care,’ she said.
The doctor also pointed out the healthcare system currently faces a shortage of GPs. The need is great, especially with the increasing population, but Healy says it will only worsen if GPs continue to be underappreciated and compensated.
Commenting on the piece, a Redditor sarcastically said, ‘Wow, it’s like the last nine years of Governance has purposely pulled the rug out from under Medicare in an attempt to ruin it and then privatise it due to it being so f*****. I’m shocked. So very, very shocked.’
Another agreed with the article but noticed a gap in discussion: ‘The central idea is correct: GPs cannot afford to bulk-bill. But after the author mentioned "Medicare freeze" once, they never came back to the main cause of the problem.’
Others felt it was only right to ask GPs for bulk billing: ‘Because taxes go towards the public health system, why is it such an outrageous idea that a tax-paying citizen that pays for public health care would "demand" not having to pay to see a doctor? Taxes don't go towards vets, retailers or luxury items the same way (through backroom lobbying bull****, they do, sadly).’
One commenter tried to see from the perspective of doctors: ‘I suspect GPs feel it's very fair to ask for tax dollars to support your healthcare, but they'd really prefer those requests be directed to those allocating public funds and not to the person with zero control over it.
‘The article makes the point that when you ask to be bulk-billed, you ask the GP to choose to make less. As an individual, you receive the same financial support from Medicare regardless of whether you're bulk-billed or not.’
Still, it’s not a good situation all-around: ’It is an inaccurate knee-jerk reaction to blame the usual scapegoats of this type of s***. The reality is that public health is in a f***** place right now.’
What are your thoughts on the crisis? Have you (or your friends) been affected by the shift from bulk billing? Feel free to share them with us in the comments!
Bruce Willett, vice-president of the Royal Australian College of GPs, has been a medical doctor for decades. In recent years, his practice was put in a tough position after Medicare failed to fill the gaps caused by rising operational costs.
‘We're really concerned for our patients and have tried hard to keep up bulk-billing to support those patients to obtain the health they need,’ the GP said to ABC News.
But many doctors can no longer afford to - a recent HealthEd survey found that more than one in five GPs decided to change their billing model.
Many blame the situation on the Medicare funding freeze. Introduced in 2013, it was meant to be a temporary savings measure but has been in place since.
The Labor government increased the rebate by 1.6 per cent last month. However, Dr Willett said it is insufficient to make up for their losses, especially with Australia’s 6.1 per cent inflation rate.
Instead, Australian GPs are pushing for a hike of 10 per cent, especially for consultations that take longer. Willett said: ‘The way that Medicare is structured at the moment, unfortunately, it tends to favour shorter consultations, and we're seeing increasing levels of mental illness, increasing levels of multiple chronic illnesses, and that just takes time to work through.’
Aussies took it to social news website Reddit to react.
One user said: ‘I don't feel like we have an accessible and universal healthcare system anymore, and that is a terrible slippery slope for us to be on.’
Another sympathised with the impossible situation the doctors are in: ‘I discovered not long ago that complex wound care costs GPs money, even their normal gap barely covers the cost. I wonder how many things GPs do that they are losing money on due to supply costs and lack of medicare rebates.’
A Redditor lamented: ‘This wave of inflation will no doubt kill off all remaining bulk billing GPs given the fee rebates won't increase anywhere near inflation. It seems to be kicking off a cycle of practices going to private.’
Marie Healy, based in Redfern, is another GP who chose to stop bulk-billing after two decades of service.
In an opinion piece in The Sydney Morning Herald, she said: ‘Medicare rebates have historically undervalued our service, but the freeze several years ago compounded this. I earn at least 10 per cent less than I did six years ago. I worked at a small practice that had been operating in Redfern for more than 30 years. It closed six years ago because of this. That GP and I moved to a larger practice, which decided this year to abandon bulk-billing for all but the neediest and First Nations patients.’
Healy continued: ‘The practice takes a proportion of all our earnings to pay for nurses, receptionists, equipment and the usual running costs. In the end, it’s a matter of survival.’
Doctors say that the current billing system is unsustainable and would lead to surging fees for consultation. Credit: Karolina Grabowska
The Redfern physician says that she always has bulk-billed pensioners, but now they have to pay $20 out of pocket. In her practice, she noticed that those who could not afford the consultations were the happiest to pay.
‘Although I am concerned that fees might be a disincentive for people to access healthcare, my experience to date has been that it frequently comes down to choice, and how much people value their health and the care their GP provides,’ Healy wrote, ‘I’ve had many instances of patients insisting I bulk-bill them when they smoke a pack a day, or regularly see a naturopath, or pay hundreds to vets, or spend thousands on overseas trips or fancy dining. For some reason, they demand a discount from the GP but not the others.’
Primary care is integral to healthcare. About 85 per cent of Australians see a GP at least once a year, but Healy notes that GPs seem to be undervalued in the country. ‘There is ample evidence that primary care, delivered by GPs, helps to keep people well, improves life expectancy, and reduces the burden on hospitals, yet billions have been directed away from primary care,’ she said.
The doctor also pointed out the healthcare system currently faces a shortage of GPs. The need is great, especially with the increasing population, but Healy says it will only worsen if GPs continue to be underappreciated and compensated.
Commenting on the piece, a Redditor sarcastically said, ‘Wow, it’s like the last nine years of Governance has purposely pulled the rug out from under Medicare in an attempt to ruin it and then privatise it due to it being so f*****. I’m shocked. So very, very shocked.’
Another agreed with the article but noticed a gap in discussion: ‘The central idea is correct: GPs cannot afford to bulk-bill. But after the author mentioned "Medicare freeze" once, they never came back to the main cause of the problem.’
Others felt it was only right to ask GPs for bulk billing: ‘Because taxes go towards the public health system, why is it such an outrageous idea that a tax-paying citizen that pays for public health care would "demand" not having to pay to see a doctor? Taxes don't go towards vets, retailers or luxury items the same way (through backroom lobbying bull****, they do, sadly).’
One commenter tried to see from the perspective of doctors: ‘I suspect GPs feel it's very fair to ask for tax dollars to support your healthcare, but they'd really prefer those requests be directed to those allocating public funds and not to the person with zero control over it.
‘The article makes the point that when you ask to be bulk-billed, you ask the GP to choose to make less. As an individual, you receive the same financial support from Medicare regardless of whether you're bulk-billed or not.’
Still, it’s not a good situation all-around: ’It is an inaccurate knee-jerk reaction to blame the usual scapegoats of this type of s***. The reality is that public health is in a f***** place right now.’
What are your thoughts on the crisis? Have you (or your friends) been affected by the shift from bulk billing? Feel free to share them with us in the comments!
.png){kind=icon}
