Bulk-billing rates up but systemic funding must support multi-disciplinary teams to keep people out of hospital

Last year, the Federal government committed additional billions to tackle slipping bulk billing rates. Initial figures, after pushing to encourage more medical clinics to fully bulk bill, are in. Bulk-billing rates have risen across the nation, particularly in areas that were deemed ‘health deserts’. However experts, Peter Breadon and Molly Chapman of the Grattan Institute, say the push to elevate bulk-billing has had a side-effect, entrenching a dysfunctional funding model for general practice; Only supporting care of short appointments for straightforward needs. They say that deeper reform must support multidisciplinary teams working alongside GPs to tackle more complex issues before people, especially seniors, present to hospital and residential aged care facilities. Home care providers are also clear, they work alongside seniors to support the whole person, that takes time. GPs, nurses, psychologists and others are a key part of the support puzzle, and need to be supported to do the same.

The initial kick

At the conclusion of last year, GPs saw an uptick in Medicare payment rates, what many call incentives, to bulk bill patients. On top of an existing rebate, they were to get more. Already in 2023, the government had tripled the payment to concession holders and children, then in following up an election pledge, the government sought to make good on its goal to push towards a builk-billing rate of 90 per cent by 2030.

In order to achieve this sizable lift the government has opened wide the bulk-billing gates to all patients, not just cardholders and children. Furthering the incentive carrot, the government said it would give an additional 12.5% payment over and above the Medicare incentive. From November last year, these cumulative incentives have come into play, costing the taxpayer a further $2 billion a year.

Government figures

The government has released initial figures showing that, on the surface, the move has had an impact. Over the last three months, 81.4% of GP services have fallen under bulk-billing, having risen from 77.1 per cent a year earlier.

While it is the biggest uptick over a quarter period, it is still far from the 90% rate that the country saw during COVID, or even sitting comfortably in the mid-80 per cent range the years prior to that.

And yet in total, a sizable 3,400 medical clinics are now fully bulk-billing all services, up from 2,300 in October 2025. 

Experts are seeing the changes, yet what they are calling for is to understand that this initial momentum can be leveraged for further wide-reaching and cost-saving measures elsewhere in health.

Currently benefiting most

What experts have seen is that while bulk-billing rates have risen in every state and territory, the greatest rise has been for people in the 16-64 demographics, especially those in regional areas and in less-wealthy regions of cities.

A 4.2 percentage bump, greater than any other demographic has been seen, is understandable due to many in this bracket previously not being included in the incentive, low-income catchment.

Advocates and providers have welcomed the figures that attest the incentives have been driving up bulk-billing in ‘health deserts’, with the payment for face-to-face consults longer than five minutes $21.85 in cities and escalating to $42.05 in remote areas.

Yet experts highlight that the biggest hurdle to profoundly making an impact on wider ramifications of health and aged care beings can be understood in these figures. While making 5 minute consultations more readily accessible to all, there is the glaring omission of GPs and the system not being able to tackle complicated cases. While $2 billion extra funding has gone into the move, particularly for seniors, experts do not see holistic treatment addressed with current reform.

Missing scope

Experts Breadon and Chapman recognise that the sizable investment has started to have its impact as each week brings in increasing numbers of clinics opting to bulk bill all patients. Yet it is in expanding a limited model, that of short appointments, they and others attest, that the government has currently missed a critical piece of the systemic puzzle to have a vital impact on preventative medicine.

To partner with the critical work that home care providers are trying to deliver, particularly in regional areas, GPs maintain under pressure to rapidly cycle through patients to cover costs. Industry leaders, across aged care and healthcare are quick to point out that it is in holistic care that complicated illnesses can be treated effectively, for this, it is not only GPs that need more time.

Breadon and Chapman note that the expansion of bulk-billing has not facilitated the multi-disciplinary approach to medicine that is the most effective in keeping seniors at home for longer, and out of hospital and residential aged care early.

They frankly share that the most recent boost in bulk-billing and the $2 billion incentive push has had a side-effect cloaked in success, that of deepening a dysfunctional funding model.

They explain that Australia, systemically, is reliant on a fee-for-service payment structure for general practice. This, they explain, has translated into more funding for countless short visits, irrespective of a patient’s needs.

Breadon and Chapman share that the omission is that the current model, that has now been supercharged and tied off with a bow by the government as a success, means money is not able to be channeled through to multidisciplinary teams that work alongside and around a GP. Critical skill sets and insight of nurses, physiotherapists, psychologists and pharmacists are not part of the new push.

What the expert duo see happening is GPs speeding through consults with far too minimal support. They see the expanded model as simply unable to meet the diagnostic and treatment demand of complex chronic disease that has been showing signs of only increasing as Australia’s population ages.

The Grattan experts share that as Australians age, there are and will be rising levels of people living with multiple conditions at once. Siabetes, hypertension and heart disease have all seen marked increases. They note that while seniors, and others, may more easily access five minute appointments, the funding model of incentives is not able to channel money to the multidisciplinary teams and time required to treat the senior, and prevent these complicated chronic conditions from worsening.

Isolated GPs

Breadon and Chapman note that with the incentive to only bulk bill another consequence may yet rapidly emerge. Prior to the incentive increase, bulk-billing was tied to concession holders and youth, those predominantly with the least amount of means.

Now they hedge, as GPs switch to the system out of sincere morality and financial viability, taxpayer money is being channelled towards those that have the means to pay their way. Many in aged care have been in this discussion before, this being a keen point of delicacy in the aged care funding debate, and the pursuit of what is fair to safeguard both industry viability and taxpayer burdens.

Alongside Chapman and Breadon, there are advocates who raise the concern that as Australia’s population continues to age into aged care, and sadly, oftentimes, early admission into hospital, far from the ‘wealthy boomers’ that have been painted, many are of low means. They see increasingly fraught discussions oncoming, as to who gets subsidies. Supporting the vulnerable and where the money is to come from within the taxpayer base is only set to become a more pertinent topic in government and sector.

Other approaches

The team note that New Zealand from 2026 has legislated that GPs will receive more government payment for seeing disadvantaged patients.

Chapman and Breadon also remind those in policy making decisions that two independent reviews conducted in Australia, commissioned by the Federal government, alongside the Grattan Institute, recommended Australia pivots to see reform usher in alignment with other countries to make general practice funding fairer.

What the reviews called for was “blended funding”, essentially bringing in a dynamic model of public and private funding according to each patient’s needs and wealth, to result in a custom fee and appropriate time for each visit.

Reform needed

While the government is praising the spike in bulk billing, and many patients are seeing benefits from easier access to the GP, the duo are offering caution about cheering too soon. Gains must be sustained for impact. And the impact and scope should and must be expanded to preventative medicine and easing hospitals and residential aged care admissions.

Public taxpayer money must always be spent with utmost care and efficacy of outcome, Breadon and Chapman note. “Tipping money” into ineffective funding of care, in the long run, without bringing down the seniors presenting early to hospital, strain on healthcare systems, and overcrowding RAC with the beds that aren’t there is detrimentally wasteful.

The team advocate that the system must support multi-disciplinary teams to be paid to work effectively together, to diagnose and treat the whole person, whether that takes five minutes or fifty. Even at 90% builk-billing targets met, if it is ever done so, the team see that reform must be actioned to fund and reflect a patients’ full needs, health and wealth.

It is widening the scope of reform, and what success is that the duo see Australia’s health-care system becoming ready in effectiveness, fairness and cross sector sustainability.