The Mudgee Medical Centre is currently experiencing a crisis level surge in patient demand. Simultaneously, it contends with overwhelming budgetary challenges, despite a recent federal government commitment to raise the bulk-billing rates for general practitioners (GPs). Colleen Best, the centre’s manager, asserts that the new initiatives will not alter the practice’s current billing structure. On a recent morning, the center opened to a line of more than 20 eager patients waiting for last-minute appointments. In fact, all the parking spots had filled up within only ten minutes.
By the end of the decade, they want to eliminate the cost of nine in 10 visits to GPs. The goal of this trial is to provide financial incentives through bonuses for doctors who bulk-bill all patients, rather than just those that are eligible for concession. Best reiterates that the Mudgee Medical Centre will continue its practice of only bulk-billing pensioners and health care card holders. They will make clear that policy applies to certain patients under 16 years old. She factors that 65 percent of their patients now enjoy the fruits of bulk-billing. At the same time, the other 35 percent spend $108 out-of-pocket for private consultations.
Government Promises and Financial Realities
Federal Health Minister Mark Butler made it clear this week that the federal Labor government is serious about improving access to healthcare. He said that only six-in-10 practices would predictably bulk-bill under the new scheme. This would be a dramatic jump from today, where only one in ten practices are managing to do so. The government has announced an investment of $8.5 billion into this initiative which will see more GPs transition to full bulk-billing.
Even with these plans in place, though, Best is still doubtful about how realistic they are on the ground at the Mudgee Medical Centre. She wrote that moving the center to 100% bulk-billing would lead to a deficit of $21 per patient consult. In that case, the center would only get back $87.
“Every month it’s a battle to make this place earn more than we spend.” – Colleen Best
This significant financial pressure introduces doubts about whether the model can be sustained in the rare event it were to go fully bulk-billing. During our conversation, Best acknowledged that these new changes would make the problem worse, not better.
“They’ve just made our problem worse because now we’re going to be listening to people whingeing about not being able to get into a doctor, and then people whingeing about not being bulk-billed.” – Colleen Best
Concerns Among General Practitioners
Dr. Michael Wright, president of the Royal Australian College of General Practitioners (RACGP), echoed similar concerns among GPs across the nation. He shared the results from a survey of more than 840 practitioners. It was found that 92.4 percent of them would not convert to complete exclusive bulk-billing, even under these suggested reforms.
Wright shone a light on the obstacles experienced by women GPs. They have considerably longer time with their patients, which in turn invites more stress from billing practices.
“I’ve had a lot of concerns, particularly from female GPs, who spend more time with their patients on average, that they are going to be more disadvantaged.” – Dr. Michael Wright
There are concerns about how these adjustments would impact patient access, especially in dense urban communities. As Dr. John Deery explained, there are disincentives to urban GPs when it comes to bulk-billing. He feels that these challenges should not be determined by one’s geographic area.
“There are plenty of people doing it tough in metropolitan areas but there’s a disincentive for urban GPs to bulk-bill. It shouldn’t be a postcode lottery.” – Dr. John Deery
Future Implications for Healthcare Access
The federal government’s plan is designed to do more than just encourage doctors to bulk-bill — it aims to increase healthcare access to rural and regional areas. Andrew Cohen, another deep believer in healthcare enabling the new political paradigm, explained the scheme’s promise. He hopes it will produce a more sustainable model for GP practices.
“Before this your average billing practice was break even at best but this will provide the kind of margins that make it a more sustainable, viable model.” – Andrew Cohen
Cohen went on to stress the importance of reinforcing general practice in outer suburban communities. These communities have become highly reliant on local healthcare providers to meet their medical needs.
“This is about bringing workforce into outer suburban areas where there are real shortages and showing doctors they can create a solid career from bulk-billing.” – Andrew Cohen
Getting to those aspirational goals will require time and collaboration from everyone across the health care delivery chain.
Health Minister Mark Butler uncritically lauding the design of the policy. He’s convinced it hits that sweet spot between what’s best for patients and what’s best for GPs.
“I can’t make them do that … but I’m confident we have designed this in a way that’s in their interests to do this as well as obviously in the interest of patients.” – Health Minister Mark Butler.
Shadow Health Minister Anne Ruston reaffirmed commitment to working with GPs to ensure timely and affordable access to healthcare for all Australians.
“We will continue to work closely with Australia’s GPs if elected to ensure all Australians have timely and affordable access to the healthcare they need.” – Shadow Health Minister Anne Ruston
