People are beginning to question the math behind DoHAC’s prediction that swathes of clinics will return to universal bulk billing in the wake of new investments.
Health Minister Mark Butler is maintaining that switching to universal bulk billing will be in the best financial interest of the majority of general practices across the country, as GPs, politicians and reporters alike start to question the numbers.
Speaking in Adelaide today, Mr Butler defended Labor’s funding pledge of $8.5 billion for Medicare should they win the next election.
The bulk of that sum would go toward extending the bulk-billing incentive to cover all Australians and adding a new Practice Incentive Program payment for practices that commit to universal bulk billing.
Labor’s modelling indicated that the number of universal bulk-billing practices in Australia would triple to 4800 under the new measures.
In Senate Estimates on Wednesday, Independent ACT senator David Pocock confirmed that the projected number of universal bulk-billing clinics in the territory would rise to 27.
There are currently two universal bulk-billing clinics in the ACT.
Mr Pocock said he had reached out to all 80 clinics across the ACT to ask whether they would switch to universal bulk billing because of the incentive; of the 25 he heard back from, every single one had said no.
Australian GP Alliance chair Dr John Deery, who is based in Canberra, told The Medical Republic that he doubted that a high number of practices would take up the offer.
“I think it’s extremely unlikely that, after having made the effort to transition to private billing, practices will voluntarily move back to bulk billing and – even with the perceived extra money – will be making less than the year before,” he said.
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RACGP ACT and NSW chair Dr Rebekah Hoffman told TMR that the ACT has had historically low numbers of bulk-billing practices and high out-of-pocket costs.
“The profit margins on general practice is roughly 1% to 3%, so asking practices within an MMM1 location to reduce their fees by 30% – which is roughly what it would be if you’re moving from charging a Level B at $101, which is what the ACT average is, down to $65, which is what it would be with the bulk-billing incentive plus the [PIP],” she said.
“That’s a reduction of more than 30% of their financial intake, and that’s unlikely to be viable across the board for more than half of the practices in the ACT.
“Medicare has been underfunded, and we need to have more investment into Medicare, but I don’t necessarily think this is going to make a large or even small difference in the ACT.”
When Mr Butler was questioned directly by a reporter on whether he conceded that doctors would still be out of pocket if they switched to universal bulk billing, he said that the modelling had been done “really carefully”.
“Our modelling is very clear,” he said.
“We have a good line of sight of general practice income, practice by practice, and we are able to model which practices will be better off and which won’t.
“We are confident that for the majority of practices across the country, it is in their financial interest to take up this offer and become fully bulk-billing practices.”
The rest, he said, will continue to charge gaps to “some patients coming through, on higher incomes”.
Mr Butler also defended the decision not to just raise the rebate for general consultation items.
“I do want to say though, that in some of the commentary since Sunday, some doctors have said they would prefer if we just gave this money through an increase to the rebate, with no strings attached,” he said.
“I understand why some doctors or practice owners might want that, but I couldn’t in good conscience do that without guaranteeing a good patient outcome on bulk billing.”