<?xml version="1.0" encoding="ISO-8859-1"?> <docID>338929</docID> <postdate>2025-02-24 12:05:51</postdate> <headline>What the Medicare boost means for patients</headline> <body><p><img class="size-full wp-image-338930" src="https://citynews.com.au/wp-content/uploads/2025/02/20250223167069063722-original-resized.jpg" alt="" width="900" height="601" /></p> <caption>Prime Minister Anthony Albanese announces increased Medicare funding in Launceston. (AAP Image/Rob Burnett)</caption> <p class="theconversation-article-title"><span class="kicker-line">Labor and the Coalition have pledged to raise GP bulk billing. <strong>STEPHEN DUCKETT</strong> explains what the Medicare boost means for patients.</span></p> <div class="theconversation-article-body"> <p><strong>Labor yesterday foreshadowed a major Medicare change to address the falling rate of bulk billing, with an <a href="https://theconversation.com/albanese-pledge-nine-in-ten-gp-visits-bulk-billed-by-2030-in-8-5-billion-medicare-injection-249948">A$8.5 billion election announcement</a>. The government said it would increase incentive payments for GPs to bulk bill all patients, from November 1 2025.</strong></p> <p>Today the Coalition <a href="https://peterdutton.com.au/dutton-ruston-media-release-the-coalition-will-invest-9-billion-into-medicare/">said it would match</a> Labor’s Medicare investment dollar-for-dollar.</p> <p>Medicare was designed as a universal scheme to eliminate financial barriers to access to health care. The contemporary slogan is that you only need your Medicare card, not your bank card, to see your doctor.</p> <p>But <a href="https://www.health.gov.au/sites/default/files/2024-08/medicare-statistics-per-patient-bulk-billing-dashboard-2023-24.pdf">fewer than half</a> of Australians are always bulk billed when the see a doctor. So how did we get into this situation? And what could these changes mean for access to care?</p> <h3><span style="color: #800000;">Why bulk billing has been declining</span></h3> <p>Until changes introduced by then Health Minister Tony Abbott in 2003, Medicare was the same for everyone.</p> <p>But in response to declining rates of GP bulk billing at the time, the then Coalition government backed away from Medicare’s universality and introduced <a href="https://www.naa.gov.au/explore-collection/cabinet/latest-cabinet-release/2003-cabinet-papers-context#economic">targeted bulk billing incentives</a> for pensioners and health-care card-holders, children, people in rural and remote Australia and, in a political fix to <a href="https://australianpolitics.com/2004/03/10/abbott-announces-medicare-plus-deal-with-senate-independents.html/">appease then Tasmanian independent Senator Brian Harradine</a>, all Tasmanians.</p> <p>Fast-forward to 2014 and then Health Minister Peter Dutton introduced legislation as part of the budget for <a href="https://www.abc.net.au/news/2015-03-03/timeline-dumped-medicare-co-payment-key-events/6275260">a compulsory copayment for GP consultations</a> – a proposal that did not survive six months and failed in the Senate. A <a href="https://theconversation.com/back-to-the-future-with-coalition-attacks-on-medicare-bulk-billing-35311">smaller optional payment</a> also failed to get approval.</p> <p>But the idea of getting Australians to pay out of pocket to see a GP survived. It was introduced by stealth by <a href="https://theconversation.com/what-is-the-medicare-rebate-freeze-and-what-does-it-mean-for-you-114169">freezing GP rebates</a>, rather than adjusting them to inflation. This slowly forced GPs to introduce patient co-payments as their costs increased and their rebates didn’t.</p> <p>By the time Labor was elected, bulk billing was said to be in <a href="https://www1.racgp.org.au/newsgp/professional/the-result-of-years-of-neglect-bulk-billing-freefa">freefall</a>.</p> <p>Labor’s first response was to restore the indexation of rebates, so they increase increase in line with inflation in November of each year.</p> <p>It then <a href="https://theconversation.com/health-budget-has-big-changes-reviving-our-worn-out-medicare-fee-for-service-system-and-boosting-bulk-billing-204527">tripled the bulk billing incentive</a>. This meant GPs received a greater rebate when they didn’t charge patients an out-of-pocket fee.</p> <p>But the new incentive was not enough to cover the gap between rebate and fees in metropolitan areas.</p> <h3><span style="color: #800000;">What proportion of Australians are now bulk billed?</span></h3> <p>Only about <a href="https://www.health.gov.au/sites/default/files/2024-08/medicare-statistics-per-patient-bulk-billing-dashboard-2023-24.pdf">48% of people</a> have the security of “always†being bulk billed when they see a GP. A further 24% are “usually†bulk billed.</p> <p>Bulk billing rates are highest in poorer areas – southwest Sydney has an “always†rate of 81%, almost quadruple the rate in the ACT (23%), which has Australia’s lowest “always†rate.</p> <p>The always bulk billed rate – excluding special covid items that required bulk billing – has dropped from about <a href="https://www.health.gov.au/sites/default/files/2024-08/2022-06_-_mbs_financial_year_statistics_-_patient_bulk_billing_ranges_dashboard.pdf">64% in 2021–22</a>.</p> <p>The rate of bulk billing as a percentage of all visits to the GP, rather than people, is much higher. <a href="https://www.health.gov.au/sites/default/files/2025-02/medicare-statistics-year-to-date-dashboard-july-to-december-2024-25.pdf">Around 78% of all attendances (aka visits)</a> in the second half of 2024 were bulk billed. The higher rate is because more frequent users, such as older Australians, are bulk billed at a higher rate than younger people.</p> <h3><span style="color: #800000;">What does the new bulk billing package include?</span></h3> <p>The initiative announced yesterday includes three positive changes.</p> <p>First, it again increases the bulk billing incentive.</p> <p>It also introduces an additional bonus for general practices which achieve 100% billing.</p> <p>The new combined Medicare rebate in metropolitan areas for a standard bulk billed visit to the GP is A$69.56 when both changes are applied. This is $27 above the current rebate of $42.85 (without any bulk billing incentive).</p> <p>The current average <a href="https://www.health.gov.au/resources/publications/medicare-quarterly-statistics-modified-monash-model-locations-december-quarter-2024-25?language=en">out-of-pocket payment</a> when a service is not bulk billed is $46. So there will still be a gap, but the difference between bulk billing and not is now significantly smaller.</p> <figure class="align-center "><img src="https://images.theconversation.com/files/650762/original/file-20250223-33-l77dzj.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/650762/original/file-20250223-33-l77dzj.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=334&fit=crop&dpr=1 600w, https://images.theconversation.com/files/650762/original/file-20250223-33-l77dzj.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=334&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/650762/original/file-20250223-33-l77dzj.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=334&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/650762/original/file-20250223-33-l77dzj.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=419&fit=crop&dpr=1 754w, https://images.theconversation.com/files/650762/original/file-20250223-33-l77dzj.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=419&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/650762/original/file-20250223-33-l77dzj.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=419&fit=crop&dpr=3 2262w" alt="" /><figcaption><span class="caption"><em>*Totals include item Medicare rebate, Bulk Billing Incentive item rebate, and 12.5% Bulk Billing Practice Incentive Program payment</em>.</span><br /> <em><span class="attribution"><span class="source">Government Press Release</span></span></em></figcaption></figure> <p>The government expects a major uplift – to 90% of visits bulk billed – as a result.</p> <p>State government payroll taxes, also <a href="https://www.sro.vic.gov.au/payroll-tax/payroll-tax-and-medical-industry">encourage bulk billing</a>, by not requiring GPs to pay payroll tax on consultations that are bulk billed. This will provide a further incentive to increase the bulk billing rate.</p> <p>The second positive change is that the new initiatives are for everyone. This ends the two-tiered incentive the Coalition introduced in 2003 and restores Medicare as a truly universal scheme.</p> <p>Australia will now rejoin all other high-income countries (other than the United States) in having health funding underpinned by universality.</p> <p>Third is the introduction of a 12.5% “practice payment†bonus for practices that bulk bill all patients.</p> <p>This starts the necessary transition from a reliance on fee-for-service payments as the main payment type for general practice.</p> <p>A “practice payment†is more holistic and better suited to a world where more people have multiple chronic disease which require care for the whole person, rather than episodic care. It signals payments need to be redesigned for that new reality.</p> <p>Over time, this could fund and encourage multi-disciplinary teams of GPs, nurses and allied health professionals such as psychologists and physiotherapists – rather than patients always seeing a GP.</p> <h3><span style="color: #800000;">The downsides</span></h3> <p>The main risk practices face in contemplating these changes is the fear of how long this new scheme will last. A previous Coalition government showed it was prepared to use a rebate freeze to achieve its policy of a shift away from Medicare as a universal scheme.</p> <p>The best way of reducing that risk would be to build in indexation of the rebate, and the incentive, into legislation.</p> <p>The Royal Australian College of GPs <a href="https://www.theguardian.com/australia-news/2025/feb/23/coalition-to-match-dollar-for-dollar-labors-plan-to-make-gp-visits-cheaper-in-85m-medicare-boost">says</a> not everyone will be bulk billed because rebates are still too low to cover the cost of care.</p> <p>This is true, as the gap between the prevailing metro bulk billed fee and the new rebate plus incentive will be about $20. But the aim is to increase bulk billing to 90% not 100% – and that is probably achievable.</p> <h3><span style="color: #800000;">Bottom line</span></h3> <p>The new arrangements will likely reverse the decline in the rates of bulk billing. The government can reasonably expect a bulk billing rate of around 90% of visits in the future.</p> <p>For consumers facing cost-of-living pressures, it will be a very welcome change. There will be more 100%-bulk-billing practices and patients will no longer face a lottery based on a doctor’s or receptionist’s mood or whim about whether they will be bulk billed.</p> <p>Yesterday’s announcement and the Coalition’s backing is a watershed, benefiting patients and general practices.</p> <p>Labor is playing to its strengths and it will hope to reverse its current polling trends with this announcement.</p> <p>The Coalition obviously hopes to negate the impact of a popular announcement by matching it. What will weigh in voters’ minds, though, is whether today’s Coalition announcement will be delivered after the election. The Coalition has a <a href="https://theconversation.com/labors-mediscare-campaign-capitalised-on-coalition-history-of-hostility-towards-medicare-61976">long history</a> – dating back to <a href="https://electionspeeches.moadoph.gov.au/speeches/1975-malcolm-fraser">Malcolm Fraser</a> – of <a href="https://www.abc.net.au/news/2014-05-07/abbott-promises-no-cuts-to-education-health/5436224">promising one thing</a> about health policy before an election and reversing it after the vote, and this will probably fuel a “Mediscare†campaign by Labor.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/250604/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/stephen-duckett-10730">Stephen Duckett</a>, Honorary Enterprise Professor, School of Population and Global Health, and Department of General Practice and Primary Care, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne.</a> Republished from <a href="https://theconversation.com">The Conversation.</a></em></p> <p>https://citynews.com.au/2025/dutton-launches-a-game-of-one-upmanship/</p> </div> </body>