Change bulk-billing, Medicare rebates with caution, Australia

There is no association between bulk-billing by GPs and shorter consultation times, according to research published in the Medical Journal of Australia.

An online survey of 2477 Australians aged 16 years or older found that 83% (2064) attended a general practice that bulk billed some or all of its patients, and that 71% (1763) 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.

The researchers - led by Mr Richard De Abreu Lourenco from the University of Technology, Sydney - found that "the odds of being bulk billed was negatively associated with larger practice size, respondents having had an appointment for their visit, higher household income and inner or outer regional area of residence".

"It was positively associated with the presence of a chronic disease, being a concession card holder and having private health insurance", they wrote. "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 (other than price) 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. The authors suggested that could be explained by healthier individuals being more willing to discriminate between practices and better able to find bulk-billing GPs.

They cautioned, "These [those with concession cards, chronic disease and lower incomes] are the groups who would be the most disadvantaged by the introduction of additional copayments for GP visits".

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