Inching towards progress, bulk-billing changes have arrived – Regional Australia is set to see a sizable uptake

November has seen some hefty changes for the health and aged care space. Perhaps not as loudly trumpeted, but nevertheless equally intended to bring about positive change from a government perspective, is the bulk-billing funding changes announced by the current Labor government. With the $7.9 billion government investment into Medicare, lauded as a “historic” funding moment, the effort is intended to revive the arguably sickly state bulk-billing has slid into following the years of the pandemic.

Intention

The billions being put forward into Medicare is intended to make seeing the GP a more viable and accessible possibility for the average Australian, particularly senior or those of low means. As the new incentives are rolled out to entice doctors to join up, the scheme comes with an ambitious goal, bulk-billing every visit.

Key players in both the health and aged care space are however hesitant to place a full stamp of effective approval, as the government has made it clear that the scheme is not mandatory, and numerous physicians have spoken to media outlets voicing their intention to resist being a part of the effort due to treatment and financial complexities of care.

As it stood

Prior to November 1 and the incoming scheme, GPs were able to receive a financial contribution from the federal government each time they bulk-billed certain people, those people being children under 16 and concession card holders.

The numbers looked to be around $21.85 for a physician in city areas, for a 6-to-19-minute standard appointment, but with the potential to rise higher for rural and further flung areas.

The change

Under the new scheme, GPs will be able to receive the financial injection from the government when they opt to bulk-bill any patient.

The scheme describes that it applies to “eligible services”, inclusive of short, standard and long appointments. However, the Royal College of GPs and its doctors are warning the scheme does not apply to every reason and procedure a patient may see the GP for, and to be prepared for the possibility of out-of-pocket fees for some procedures remaining.

The government has further detailed further levels of the scheme to entice clinics and doctors to entirely opt in to the bulk-billing approach.

If the entirety of doctors under the banner of one clinic, bulk-bill the entirety of patients for the “eligible” services, then the government has committed to further financial reward.

For clinics and doctors that meet this condition, the government has stated that they will receive a 12.5 per cent payment on each dollar that the clinic earns through the Medicare program, which will in turn be paid out quarterly, divided between doctors and clinics.

Seniors accessing preventative care

Aged care leaders and advocates are unanimous, a reasoned and researched part-measure to reduce the strain on hospitals, RAC and in-home aged care services is to reduce the barriers for seniors to see GPs.

Speaking to the ABC, GP Mark Fitzmaurice shares how doctors have felt caught between soaring clinic costs and wanting to provide accessible and timely preventative, and reactive care. For 24 years he’s bulk-billed every service including procedures but as operational costs rose last year, the difficulty of staying the bulk-billing course intensified.

“I’ve resisted, but it’s been hard to resist moving to mixed billing,” he shared with the ABC.

In response to the new inventive scheme, he and his clinic will be able to continue in their fully bulk-billing approach, as he outlines that each doctor is likely to bring in an extra $1000 a week.

In his interview he implores other doctors to give the new scheme a go.

“I know it’s complicated, so I spent hours doing the calculations … and it’s the patients who really suffer if you don’t swap over.”

Dr Fitzmaurice shared a break-down of the numbers with the ABC, highlighting a key marker of how the scheme may prove highly beneficial to those seeking treatment.

His break-down sheds insight into the negative trend of financial dissuasion, particularly to seniors, when assessing whether they can see their GP.

He shared that a doctor who mixed-billed with standard appointments and fees could see a loss of around $70 a day if they opted into the bulk-billing initiative with all patients. However, the 46 average patients seen in a day by a physician could see a collective $500 of savings, with the choice of the clinic and doctor to move away from the mixed-billing model.

For full and part-pensioners, as well as self-funded retirees, every dollar counts.

Valuable doctors and valued patients

In his interview with the ABC, Dr Fitzmaurice hopes that doctors be open-minded to the scheme, wary of fully adopting the rhetoric that the scheme may devalue the work of GPs or pigeon-hole them into a vulnerable dependence on the government.

He shares, “”This isn’t the government tricking us … this is about patients and their welfare — it can’t be that they can only see a doctor when they can afford it.”

He does suggest the government improve the “unnecessary” complexity and tediousness of signing up to the program, so as to streamline the process and facilitate more clinics signing up.

The scheme is looking to have a particularly favourable uptake and impact in rural Australia, a welcome relief to health and aged care systems in the region, currently experiencing concurrent crises in meeting the health and aged care needs of thousands.

The Royal Australian College of GPs assesses that around seventy-three clinics in bigger rural towns are planning to make the switch to the new scheme, with the highest uptake looking to come in small rural towns. They predict that over 60 per cent of the 243 clinics who have indicated uptake interest do not currently bulk bill the entirety of their patients.

These numbers are welcome news for many aged care leaders and advocates in rural areas who have seen consistent early admission into RAC for seniors who may have had preventable declines in health at home.

Physicians signing up

RACGP gave voice to Port Adelaide’s Trinity Medical Centre, a clinic that is switching to the scheme to fully bulk bill due to the change in financial incentives.

Dr Loh of the clinic shared through the RACGP, “I always believe that bulk billing is a good way to practise medicine because we don’t want patients to make decisions about their healthcare based on their financial circumstances, but more what their health needs.”

“We couldn’t bulk bill previously because the gap between concession card holders and non-concession card holders was getting big, and it wasn’t financially viable for us.”

“But now that we’ve increased the new subsidies and incentives, we are able to bulk bill all patients.”

Opportunity for further change

Looking at the RACGP’s recent messaging, the current scheme was not in their sights. With the publishing of the health of the nation report, it was higher rebates for longer appointments that was lobbied for, to assist GPs to see and handle patients presenting with higher complexity issues.

Further work and iteration of policy is seen as warranted by many physicians and aged care leaders, as debate continues to wage in open and closed spaces. However an inch forward with the uptake of the scheme with some clinics, may likely benefit thousands of Australians who otherwise may have forfeited care.

RACGP’s President, Dr Wright seeks to highlight that the government has further work to do to fully encompass, in data, analysis, and subsequent schemes, the “full complexity and costs of providing care”.

The GPRA website states for Dr Wright, “It also does not consider the non-patient facing time that GPs undertake to ensure safe care, including checking results, other non-remunerated administrative tasks, and ongoing education.”

While many GPs have voiced a resistance to the scheme with evidenced backed concerns, detailing it is not enough to cover the complexity and cost of providing care, for many in aged care, the scheme is a step in the right direction to dismantling financial barriers for seniors seeking care, particularly preventative care.

As is the case with the difficult, complex and dynamic nature of healthcare and aged care in Australia, change can be painfully slow. As is healthy in humans and policy, open, consistent, and respectful discussion, inclusive of all parties, will continue to be core to the efficacy of treatment and progress.