Medical Journal: Bulk-Billing Doesn't Mean A Shorter Consultation With The Doctor

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Bulk-billing, when the Medicare benefit is taken as full payment and the patient pays no extra, doesn’t mean a shorter amount of time with the doctor, according to research published in the Medical Journal of Australia.

An online survey of 2,477 Australians aged 16 years or older found that 83% (2064) attended a general practice which bulk billed some or all of its patients, and that 71% (1,763) had been bulk billed for their most recent GP visit.

The mean out-of-pocket cost for those who were not bulk billed was $34.09.

And the chances of having to pay that extra is increased if the GP’s practice is large, if you make an appointment rather than just turning up and if you have a higher household income.

Richard De Abreu Lourenco of the University of Technology, Sydney, says there was no association between bulk-billing and duration of GP visit, age or sex.

Smaller practices had higher odds of bulk-billing than larger practices, possibly due to limited avenues for competition, such as pathology services being co-located with larger practices.

Despite bulk-billing incentive payments for GPs in regional, rural and remote areas, lower rates of bulk-billing were found in inner and outer regional areas.

The surprise finding was that, after adjusting for income and the presence of a chronic disease, having private insurance was associated with being bulk-billed.

That could be explained by healthier individuals being more willing to discriminate between practices and better able to find bulk-billing GPs.

“These (those with concession cards, chronic disease and lower incomes) are the groups who would be the most disadvantaged by the introduction of additional co-payments for GP visits,” De Abreu Lourenco and his co-authors write.

They say the current debate about increasing GP fees and reducing the Medicare rebates needs to be approached with caution.

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