>
Doctors are ditching bulk billing en masse and charging patients significant out-of-pocket costs up front, but there’s a good reason for that, according to a GP well-versed in Medicare’s struggles.
Bulk billing rates plummeted seven percent last year and have continued to fall as general practices charge higher fees to supplement Medicare reimbursements.
TikTok user Cate posted a video asking why it costs so much to see a GP now that fewer and fewer doctors are billing wholesale.
Dr Michael Mrozinski, a Scottish-born, Australian-based GP who is a strong supporter of his profession, responded, blaming Medicare and the government.
Bulk billing rates plummeted seven percent last year and have continued to fall as general practices charge higher fees to supplement Medicare reimbursements. In the image, a doctor talking to a patient.
“I’m going to explain this to the best of my ability and then you can find out whose fault it is,” he said.
‘When you come to see a GP in Australia, we charge a fee for that service.
“But that doesn’t just cover our time, it also covers our administrative staff, our nurses, our IT, facilities, all our consumables, etc.”
Dr. Mrozinski said the money paid to doctors for the services they provide to patients has not kept pace with inflation over the past four decades.
“In 1984, when Medicare was first created, for the most common item number (for example, a short query) we would get about $24,” he said.
‘That would be enough to cover all those things you were talking about.’
Dr Michael Mrozinski (pictured) is a Scottish-born, Australian-based GP who is a strong supporter of his profession.
But Dr. Mrozinski said that by 2023 “that number should be closer to $60, and unfortunately the government hasn’t increased the Medicare reimbursement, so it’s still at $39.”
The GP said that while equipment, staff, facilities, rent and everything else has gotten more expensive, the reimbursement paid to doctors has not kept pace.
“We don’t get more from the government to cover it and someone has to fill that gap,” he said.
Amid fears from some doctors that Medicare will completely collapse, Health Minister Mark Butler said the problem is that “the average gap fee is now more than Medicare reimbursement itself.”
‘What this means is that too many Australians simply cannot get the care they need, when and where they need it, in the community.’
When Medicare was created in 1984, health care consisted primarily of treating acute conditions, such as injuries and one-off illnesses, but now it is more about chronic conditions. In the image, a hand holding a Medicare card.
Wait times for GP appointments have skyrocketed to over a month for some doctors as demand increases due to population growth, while the number of GPs declines as more doctors they move on to more lucrative specialized fields.
Australia’s population is also aging rapidly, meaning more patients are living longer but need treatment to manage chronic diseases.
As a result, many people go to hospital emergency departments for routine problems because they cannot access a GP.
Rising gap fees mean experts and the government fear that without serious reform, access to primary health care will be out of reach for millions of Australians.
Experts also worry that the entire Medicare system could collapse under the weight of fewer primary care doctors, higher operating costs for surgeries and a population that is increasingly expensive to keep healthy.
“What we know we have to do is fix primary health care,” Prime Minister Anthony Albanese told Channel 7’s Sunrise channel.
“The biggest thing we’re looking at is how to take the pressure off the system, and we’re doing that: talking to the AMA (Australian Medical Association), talking to the Royal Australian College of GPs, talking to experts.”
Butler said that when the system was designed, healthcare was primarily about treating acute conditions, such as injuries and one-time illnesses.
But as Australia’s birthrate dropped and its population aged, doctors began spending more and more time treating chronic conditions in older patients.
Australians are also living longer, so the time they need to access this type of care has increased, rather than dying before it becomes a problem.
Chronic patients have very different needs than the acute ones Medicare was designed to meet, including longer visits and more frequent visits.
They also need access to allied health professionals such as dietitians, physical therapists, and chronic disease experts for specialized care.
The government admitted that the government system that subsidizes individual consultations through GPs is no longer fit for purpose.
“We need physicians to work hand-in-hand with nurses, health professionals and pharmacists,” Butler said.
“The system is not well designed to allow them to do that. Clearly, an expansion of multidisciplinary care is key to managing chronic disease.’