Let’s have a thorough conversation about bulk billing
BY AMA VICE PRESIDENT DR TONY BARTONE
In recent days we have had the release of data showing the number of Australians using bulk billing has reached a record high, with visits to GPs rising by more than three million last year and bulk billing numbers increasing by 0.6 of a per cent to 85.7 per cent. Proof, one might say that Medicare is now more than ever well supported by the community, Government and doctors alike right? How can this be in the fourth year of an indexation freeze?
The Government-released figures, which are published on a quarterly basis, point to a very slight but definitely increasing trend in terms of the number of consultations that are being bulk billed. They reveal that the cost of Medicare benefits has tipped the $22 billion mark, having risen four per cent.
The figures do not reveal the number of Australians being bulk billed and the proportion of patients who are bulk billed.
We know in fact that it remains somewhat difficult at times for some patients to find a bulk billing doctor.
Furthermore, it is clear that a lot of work is being done by doctors to address a growing trend that some patients are unable to meet all their healthcare costs. Doctors are recognising that pressure on their patients and are often trying to accommodate their needs. Doctors sense that pressure and feel the unease that patients are under. At the same time doctors are working harder and longer to try and accommodate pressure to bulk bill patients who need that support.
On the flip side, we know that for the portion of the population that isn’t being bulk billed, their out-of-pocket expenses, especially in light of the current freeze, have been growing significantly over the past years. They are finding that they’re dipping into their pockets even more than they have in the past.
So it’s a two-edged sword.
GP clinics are all small businesses with increasing costs that have had to be met in the face of a frozen rebate for many years now. So it is no surprise that at the end of the day, the pressures are building and will continue to build.
Something’s got to give and, unfortunately, what we’ll probably find is that spring will keep being wound tighter and tighter until the ability to fund those increasing expenses comes to a head. GPs and clinics need to ensure their viability long term and avoid the dilemma of potentially deciding between the number of consultations and what can be done within a given consultation.
We know from recent data that consultation lengths have been increasing. The average consultation is approximately 15 minutes according to the last set of BEACH data. That has been a steadily increasing trend and it’s not surprising given the increase in chronic disease and ageing demographics of our patients.
Unfortunately, doctors are being put in a situation where they need to increase their efficiencies even beyond what can be normally done, while also trying to accommodate the patient need for a bulk billing consultation item as opposed to charging a fully private consultation item.
The increasing spend on Medicare will no doubt be used as evidence by Government that spending needs to be controlled and justifying the freeze and that the level of MBS rebates is adequate. Advocacy for increases in MBSrebates is of course very difficult in such an environment.
Most of us will acknowledge that there is a need to ensure that Medicare remains robust enough to ensure it is equitably accessed by those in community most in need. While it might be politically a taboo topic, unless the Government is prepared to lift its investment in General Practice, we must have an honest conversation about the case to support Medicare by ensuring that those who have the means to contribute to their GP care do so at the appropriate time. As such, record rates of bulk billing need to be thoroughly examined in the current climate.
Published: 12 Sep 2017