The yearly bulk billing rates have taken a significant nosedive, leaving healthcare providers with no choice but to transfer some of the financial burden to their patients. This alarming trend is a consequence of mounting expenses and the looming threat of payroll taxes that are keeping practice owners on edge.

According to recent findings from the Medicare Benefits Schedule, the national bulk-billing rates for GP services plummeted to just 80.2% in the last fiscal year, a sharp decline from their peak of 88.8% in 2020-21, marking the lowest rates seen since 2010-11, as reported by the Department of Health and Aged Care.

While there was a slight uptick in rates during the last quarter of 2022-23, the year as a whole saw a 9% decrease in bulk-billing rates for Level B consultations, an 8.6% drop for Level C, and a 5% decline for Level D.

Dr. Cath Hester, a member of the RACGP Expert Group on Funding and Health System Reform, shared insights into the situation. She expressed that practice costs have surged considerably in recent months, making the latest statistics unsurprising. Due to the rising costs of subscriptions, insurance, and consumables, many practices are compelled to reduce their bulk-billing rates to keep up with expenses. This has even led some to discontinue bulk billing for healthcare cardholders.

In the current scenario, New South Wales boasts the highest bulk-billing rates at 84.2%, whereas the Australian Capital Territory struggles with the lowest rates, standing at a mere 56.6%. This decline in bulk billing coincides with a broader cost-of-living crisis, with Productivity Commission data revealing that 3.5% of respondents who needed to see a GP in 2021-22 either delayed or skipped their appointments due to the associated costs, and in Tasmania, this number escalated to 7.6%.

According to MBS data, the average patient contribution in the past three months was $43.35, a 41% increase compared to 2012-13. Paradoxically, general practice service delivery has surged, with 43 million consultations recorded in the past year, marking a 28% increase over the past decade.

Dr. Hester highlighted that GPs are reluctant to charge patients more, but many practices are no longer able to absorb the costs of bulk billing. This puts GPs in a difficult ethical dilemma, as they genuinely dislike billing patients for essential medical care, especially when patients are facing financial hardship.

Although the May Federal Budget allocated $3.5 billion over five years to triple the bulk billing incentive and offered a $60.40 Medicare subsidy to metropolitan children and concession card holders, as opposed to the standard $39.75 rebate, these measures were not a panacea for struggling practices. In response, doctors are calling for a systemic investment overhaul, with increased funding aimed at cost containment.

A recent survey of over 200 practices across Australia found that 55% plan to reduce bulk billing and increase gap fees in 2023, with more than one-third already having made cutbacks. In addition, 78% of these practices reported higher costs in 2022 compared to previous years. The looming threat of payroll tax changes further adds to these rising costs.

The Australian Healthcare Index is a biannual survey produced by the Australian Patients Association in collaboration with the consumer healthcare platform HealthEngine. It serves as a vital tool to gauge patient experiences across various healthcare areas, such as general practice, dentistry, pharmacy, and emergency departments. The report's most recent edition, compiled from responses received last September, provides valuable insights into the challenges faced by patients in the Australian healthcare system.

The Healthcare Workforce Shortage

Topping the list of patient concerns is the shortage of healthcare workers, including general practitioners and nurses. A staggering 47% of respondents identified this as the most pressing issue. The shortage puts immense pressure on the existing healthcare professionals and threatens the accessibility of healthcare services.

ED Waiting Times and Out-of-Pocket Costs

Following closely behind, 42% of participants expressed concern over emergency department waiting times. However, the most significant revelation is the increasing out-of-pocket costs associated with GP and doctor visits, highlighted by 33% of respondents. This issue had not featured prominently in the previous report but has now emerged as a significant concern for patients.

Growing Waiting Times

Approximately four in ten patients noticed increased waiting times in the six months leading up to September. Longer waiting times can lead to delayed diagnosis and treatment, potentially impacting patient outcomes.

The Unpopularity of Telehealth

Surprisingly, the study revealed that telehealth video consults are not as popular among patients as one might think. Only 16% of patients expressed a preference for video consultations over telephone calls. This sentiment raises questions about the effectiveness and accessibility of telehealth services.

The Australian Healthcare Index report offers a sobering glimpse into the challenges patients face within the Australian healthcare system. The rising costs of healthcare, a shortage of healthcare workers, and declining patient satisfaction are issues that require immediate attention. As healthcare professionals and policymakers grapple with these challenges, the goal remains clear: to ensure that quality healthcare remains accessible and affordable for all Australians.

In conclusion, the healthcare industry is facing an unprecedented challenge, with falling bulk-billing rates, increasing expenses, and the looming specter of payroll taxes. The knock on impact on Hospitals is only just the beginning.

While some measures have been taken to alleviate the situation, a comprehensive systemic overhaul is needed to ensure the sustainability of medical practices and the accessibility of healthcare for all.