Note: Where available, the PDF/Word icon below is provided to view the complete and fully formatted document
New approaches needed to restore bulk billing.

Download PDFDownload PDF


Stephen Smith MP Member for Perth Shadow Minister for Health and Ageing

11/2003 Thursday 27 February 2003


Shadow Health Minister Stephen Smith today released new proposals Labor is considering for the restoration of bulk billing, in a speech to the Australian Financial Review Annual Health Summit.

“The widespread availability of bulk billing by general practitioners ensures that people can obtain early medical advice - without needing to worry whether or not they can afford to see the doctor,” said Mr Smith.

“That is why bulk billing is at the core of Medicare and restoring bulk billing by GPs to respectable levels is Labor’s highest health priority.

“Bulk billing by GPs has fallen by a total of 11% since the Howard Government came to office. More than half of the decline, 5.6%, has occurred in the past twelve months, and in the past six months, the rate has fallen by 4.3%.

“Since 1996, the out-of-pocket cost of seeing a GP has increased from $8.32 to $12.78 - an increase of 54%. In the past twelve months alone, the increase has been more than three times the rate of inflation.”

Mr Smith outlined a range of possible approaches that could be adopted to support bulk billing.

Direct grants for bulk billing practices in target areas

Areas of greatest need could be directly targeted with the offer of direct grant, available through a tender process, to practicing GPs.

The grants could be awarded to practices in identified areas which agree to offer a bulk billing service and other services related to the particular population health issues which face the local community.

Income support for bulk billing practices

Another approach worth considering would be to offer payments to GPs for maintaining and increasing the level of bulk billing that they offer.

It would be possible to design an incentive - with no paperwork or a minimum of paperwork - that rewards GPs the more they bulk bill. Such a scheme would amount to a top-up payment to provide extra incentives for GPs to increase their level of bulk billing.

Directly funding bulk billing clinics

Another option which would both increase bulk billing and the GP workforce in currently under-serviced areas would be to fund the establishment of clinics and offer GPs a “walk in, walk out” facility on the basis that they voluntarily agree to bulk bill. Alternatively, GPs could be remunerated by way of sessional payments from the Commonwealth, with no cost to the patient.

This could be an attractive option for areas where there is currently no GP infrastructure, in particular, new suburbs in outer urban areas with no established primary care facilities.

Rewarding practices that guarantee access to bulk billing doctors

One option for areas where there is an existing GP infrastructure but low levels of bulk billing would be to provide an incentive payment to practices that have a bulk billing doctor available at all times.

To be eligible for such a payment, practices would have to have one doctor always available for a bulk-billed consultation, but not necessarily the same doctor all the time.

This would support practices to provide a bulk billing option for patients while giving the rest of the doctors in the practice the option of private or bulk billing. It would preserve universality as it does not restrict access to bulk billing to a particular group of people.

Redirection of funding for More Doctors for Outer Metropolitan Initiative

The $80 million earmarked for the unsuccessful More Doctors for Outer Metropolitan Areas program could be better and more effectively spent on other measures which are more likely to support outer metropolitan practices and to sustain bulk billing.

The funding could, for example, be redirected either to increase rebates for practitioners in outer metropolitan areas who choose to bulk bill, or to extend the existing practice nurse initiative to outer metropolitan areas.

Funding for the outer metropolitan doctors initiative could support bulk billing by giving GPs in outer metropolitan areas higher rebates for around 2 million bulk-billed consultations a year and the employment of an additional 285 full time equivalent practice nurses.

“Unfortunately, while Labor is absolutely committed to restoring access to bulk billing in a manner consistent with universality, the Howard Government seems to be heading down the path of developing incentives that will reward doctors only for bulk billing pensioners and the disadvantaged,” said Mr Smith.

“This can only lead to one thing - Medicare becoming a second class safety net for the poor and everyone else paying more for the health care on which they have come to depend.”

Media Contact: Andrew Dempster 02 6277 4108 or 0407 435 157