Health Minister Greg Hunt said the bulk-billing rate is up and fewer patients have costs when they see a GP. Is he correct?
Updated April 09, 2019 09:50:13
In one of the first promises made in the lead up to the federal election, Labor has announced it will lift the Medicare rebate freeze if it wins government, a move since matched by the Coalition in its 2019 Budget.
Federal Health Minister Greg Hunt published a series of tweets in response to Labor’s announcement, one of which claimed: “GP bulk-billing is up nearly 4 per cent from 82.2 per cent under Labor to a record 86.1 per cent under the Coalition Government — meaning that more patients are seeing their local GP without having to pay out-of-pocket costs.”
So, have bulk-billing rates reached a record high?
And does that mean more patients are visiting GPs without having to pay?
RMIT ABC Fact Check investigates.
Mr Hunt’s claim is half-baked.
He has the numbers right, but it does not necessarily follow that an increase in bulk-billing means fewer patients face out-of-pocket costs when seeing their GP.
Department of Health statistics confirm that the bulk-billing rate has risen almost 4 percentage points since 2013 to a record high of 86.1 per cent.
However, the bulk-billing rate measures the proportion of services that are being bulk-billed, and not the percentage of patients who are being bulk-billed.
Experts told Fact Check that this meant Mr Hunt was conflating a rise in the bulk-billing rate with a decrease in the number of patients paying out-of-pocket costs, for which data is limited.
An AIHW report found only two in every three people were bulk-billed for all their GP visits in 2016-17.
This statistic was only available for a single financial year, so it is not possible to gauge whether the number is falling, as suggested by Mr Hunt.
How does GP bulk-billing work?
Items and services listed on Australia’s Medicare Benefits Schedule (MBS) are either partly or fully funded by the Australian government.
The proportion of funding provided is called the schedule fee, and is refunded to health practitioners or patients on a fee-for-service basis.
The MBS was explained in more detail in a previous fact check.
When a GP visit is bulk-billed, the doctor or medical practice accepts the schedule fee as full payment for the service provided and the patient is not required to pay anything.
GPs may elect to charge more than the schedule fee, with the difference charged to the patient.
This additional amount is known as the out-of-pocket cost.
Has the bulk-billing rate increased to record levels?
Department of Health data shows that when Labor was last in government, 82.2 per cent of GP services were bulk-billed. By 2017/18, the bulk-billing rate had increased to 86.1 per cent.
So, Mr Hunt’s figures check out.
However, The Royal Australian College of General Practitioners’ Health of the Nation Report 2018 warns that low growth in bulk-billing threatens to undermine the rate.
“While, at face value, the bulk-billing rate appears to be increasing, growth in bulk billing is lower than ever before.
“It is predicted that if growth in the bulk-billing rate continues to slow at the same rate, the bulk-billing rate will decline by 2019–20.”
Are fewer Australians paying for GP visits?
In the Health of the Nation report, the RACGP explains that the bulk-billing rate refers to the percentage of medical services in Australia that are bulk-billed.
“[The bulk-billing rate] does not represent the number of patients who are bulk-billed, nor does it represent the number of patients who are bulk-billed for all of their general practice care,” the report said.
The report points out that patients could receive a number of services during a single visit to a GP, with some of these services bulk-billed and others billed privately.
“Therefore, while it is true that 86.1 per cent of general practice services are bulk-billed, the proportion of patients fully bulk-billed (and who therefore face no out-of-pocket costs for care) is actually much lower.”
The report, which draws on an RACGP survey of GPs, found that fewer than one in four bulk-billed all of their patients.
Further, a report compiled by the Australian Institute of Health and Welfare found that of the 21.1 million Australians who had at least one Medicare-subsidised GP visit in 2016/17, 34 per cent had paid out-of-pocket at some point during the year.
An AIHW spokeswoman told Fact Check via email that the report — Patients’ out-of-pocket spending on Medicare services 2016–17 — was the first of its kind and similar data on how many patients paid out of pocket was not available for other years.
What do the experts say?
All experts consulted by Fact Check agreed that higher bulk-billing rates did not necessarily mean fewer individuals were paying for GP visits.
Margaret Faux, a lawyer specialising in Medicare and health law, told Fact Check there was “no correlation” between high bulk-billing rates and fewer individual people paying out-of-pocket.
“Bulk-billing rates are basically meaningless to consumers because the statistics are for services, not patients,” said Ms Faux, who is completing a PhD on Medicare claiming and compliance.
She added that the data referred to by the Minister included services offered by medical providers other than GPs, such as a number of services offered by specialists and doctors working with hospital inpatients.
“To connect those two statements, as Minister Hunt has done, is misleading and erroneous.”
Associate Professor Kees Van Gool, of the University of Technology Sydney, said Mr Hunt had made an assumption in his claim which would need to be tested.
“It is absolutely true that bulk-billed services have increased, but that would only translate to people if there was an evenly-distributed rate of bulk-billing,” he told Fact Check.
“But we know that’s not true — bulk-billing rates are much higher among concession card holders, for example. So some people may actually face much higher bulk-billing than others, so it is a bit of a leap of faith [to make that claim].”
Principal researcher: Ellen McCutchan
First posted April 09, 2019 06:32:49