Announcement date
23 February 2025
Link to announcement
Strengthening Medicare: More bulk billing, more doctors, more nurses
Problem being addressed
Medicare plays a crucial role in enabling inclusive, equitable and cost-effective primary care services which set the foundation for supporting universal, integrated access to health care. Through its oversight mechanism in setting Medicare Benefit Schedule (MBS) fees and funding services, the Government plays a role in ensuring that access to bulk billed primary care remains widely available to Australians as part of our universal healthcare system.
After hitting a high-point during the COVID-19 pandemic due to the impacts of mandated requirements to bulk bill certain services, the bulk billing rate for general practitioner (GP) Non-referred Attendances (GP NRA) fell from 88.8% to 77.3% over the three financial years 2021-22 to 2023-24. Over the same period, total patient out-of-pocket costs more than doubled (from $780 million to $1.66 billion), as has the proportion of people delaying or deferring GP care due to cost (from 3.5% to 8.8%). This coincided with a 4% decline in GP NRA service volumes, which has been most acutely felt by working-aged people and those living in areas of highest socioeconomic disadvantage.
Proposal
The Impact Analysis (IA) notes that the policy objectives are to: support GPs and GP Practices to provide bulk billed care; reinforce primary care as the first point of contact within the health system; and make it easier for patients to access affordable care. In line with these objectives, the IA considers maintaining the status quo (Option 1) or expanding bulk billing incentive eligibility to all Australians and implementing the Bulk Billing Practice Incentive Program (considered together as Option 2 rather than as standalone options).
- Under Option 1, patients currently eligible for bulk billing incentives (children under the age of 16 and those who hold a Commonwealth concession card) would remain eligible. Bulk billing incentives are additional payments made to medical practitioners when they bulk bill eligible patients for unreferred services. There would be no expansion to eligibility, no changes to existing incentive benefits, and no additional incentive payments introduced.
- Under Option 2, practitioners would be able to claim a bulk billing incentive where they bulk bill a Medicare-eligible patient for any GP NRA service, regardless of the patient’s age or concessional status. In addition, this option would introduce the Bulk Billing Practice Incentive Program (the Program) which would provide an additional incentive payment to the value of 12.5% of MBS revenue from GP NRA services each quarter if participating practices (and their GPs) opt into the Program and commit to bulk bill all of their GP NRA services.
- Under Option 2, expanding eligibility for bulk billing incentives to all Australians would mean an additional 15 million people would be eligible for an incentive. Further, an estimated 4,800 GP practices would join the Bulk Billing Practice Incentive Program by the end of the forward estimates. The IA estimates Option 2 would increase the GP bulk billing rate by around 10.5% by 2028-29. These two changes would see 18 million additional services per year once the program is fully implemented. This would reduce patient out-of-pocket expenditure by $2.7 billion over the forward estimates.
Assessed Impact Analysis outcome
Adequate
Assessment comments
The IA addresses the seven IA questions and provides a detailed outline of the role of government, policy objectives and consultation. To achieve a Good Practice rating as per the Australian Government Guide to Policy Impact Analysis, the IA would have benefited from further analysis of potential options and the likely impacts.
Regulatory burden
The Department of Health and Aged Care estimates Option 2 will decrease average regulatory costs by $12.8 million per year, over four years.