Radio interview with Minister Butler, ABC Adelaide – 30 October 2025

RORY MCCLAREN, HOST: Mark Butler is the Federal Health Minister. Welcome.
 
MARK BUTLER, MINISTER FOR HEALTH AND AGEING, MINISTER FOR DISABILITY AND THE NDIS: Morning.
 
MCCLAREN: Mark Butler, remind us, what changes on 1 November when it comes to the bulk billing practice incentive program?
 
BUTLER: Up until now, really, the only support for bulk billing that doctors receive is for people with a concession card; pensioners, concession card holders, people on an income below $40,000 and children under 16. And we tripled that bulk billing incentive back in 2023. The bulk billing rate for those Australians turned back around and it's about 92 per cent, those 11 million Australians. But if you don't have a concession card, your income's over $40,000 if you're a single, then there's never been any support for doctors to bulk bill you. What we've seen is the bulk billing rate for those Australians has been continuing to slide, particularly because there was a big freeze in the Medicare rebate for six years, really squeezed doctors' incomes.
 
On Saturday, 1 November, for the first time ever, doctors will get an additional amount for bulk billing every single Australian. Every episode of care that is bulk billed, they'll get an additional payment beyond the usual Medicare rebate. And if a practice bulk bills every single patient every time they come through their doors, they'll get an additional 12.5 per cent on top of all of their Medicare income. Now, we've calculated these figures very carefully because we have access to every dollar that GPs bill. And we know that three quarters of general practices will be better off under the funding offer that starts on 1 November than they currently are. It’s still up for them. I don't run general practices. I don't employ GPs in the way that happens in the UK, for example. But I'm very confident that this is in the interests of GPs and general practices, as well as obviously and most importantly being in the interest of patients.
 
SONYA FELDHOFF, HOST: You just heard from two doctors that in their practices will be going in different directions. One will be taking on board the bulk billing changes that you're advocating, and the other won't be. What indication do you have about how many doctors are going to be taking up this incentive that you're offering?
 
BUTLER: So far, there's about 7,000 practices in Australia, about 1,500 of them bulk bill every single person that comes through their door every single time. Beyond that, general practices tend to bulk bill most people, but not everyone. To the 1,500 bulk billing practices we already have, already 1,000 general practices have told us that they'll be changing on 1 November, and that number is increasing every day. In South Australia so far, 83 general practices have said to us as the government, this week we're charging a gap fee, next week we’ll be a full bulk billing practice 100 per cent bulk billing for every single patient. And that number's climbing every single day.
 
MCCLAREN: But that's also a significant number of practices in South Australia alone who are not making this change, Mark Butler.
 
BUTLER: Of course, and I've been pretty conservative with people, very honest with people that I've never expected this to change overnight. This is going to be a series of waves of practices moving here, because I think what people will find is that when a general practice realises that the practice around the corner or down the road has shifted to a full bulk billing practice, they will reconsider. They'll crunch the numbers again, and I think they'll realise that, by and large, they're going to be better off if they've moved full bulk billing.
 
Let me just give you a sense of what it means for an individual doctor. Two years ago, a full-time, fully bulk-billing GP was earning about $280,000 on average after they paid their practice costs. They tend to pay around 30 per cent of their fees to the practice. From Saturday, that same doctor would be earning in Adelaide $415,000, so a $135,000 increase in just two years. And if you're out in the bush in the country areas, that figure is more like $490,000 a year, so this is a huge increase for GPs who take up the offer to become a fully bulk billing GP.
 
FELDHOFF: Yeah, but many are pushing back on that, Minister. Pushing back on those figures that you're quoting.
 
BUTLER: Be clear, that's not our modelling. We're using the earnings calculator that the general practice sector has set up. We used their earnings calculator to get to that figure.
 
JULIAN SCHILLER, HOST: So are you saying doctors who aren't taking up this incentive are just being greedy?
 
BUTLER: No, I’m saying they’ll make their own decisions. They are businesses. What we've said, though, is that we're very confident that we've calculated these numbers so that three quarters of practices will be better off. Now, not every GP will do it. I had a conversation with my GP. They're not going to do it. They want to continue to charge gap fees, and that's a business decision for them. And patients will make a decision about whether they stay at that practice.
 
SCHILLER: You have said yesterday that in low bulk billing rate areas, you'll intervene in the market. You'll set up fully funded new practices. Is this an admission that the carrot is not working, so now you're going to try the stick?
 
BUTLER: No, what it is a recognition that there are some markets in Australia where the bulk billing rate has dropped to quite unusual levels. Canberra is one of them. There's just not enough practices in Canberra, and it means there's not enough competition in that market. There's only a few areas like that in Australia. I think Newcastle and the Hunter Valley are a concern for me. Newcastle, the bulk billing rate is much, much lower than it is in Western Sydney. You can't tell me that it's more expensive to run a practice in Newcastle than it is in our biggest city. So, there are some -
 
MCCLAREN: But back to Jules' point here, Minister. There is an element of carrot and stick here.
 
BUTLER: There will be element of stick. I want to be really clear about this. I've said to the doctors' groups they should not underestimate our determination to turn bulk billing around. Where there are markets, and there are only a couple of them in Australia, Canberra is one of them, where there's just not enough competition and doctors lock down and continue with very, very low bulk billing rates, then we will intervene in the market. I've said in Canberra we will fund the establishment of three new general practices on the condition they become fully bulk billing practices to create some competition in this market.
 
FELDHOFF: You're listening to the voice of Federal Health Minister Mark Butler here on 891 ABC Radio Adelaide. Minister, when it comes to what patients will see from Saturday, one of the criticisms has been that while these incentives are good, they only or more greatly apply to shorter visits rather than longer GP visits. Are we going to see patients from Saturday being rushed through more quickly than they have in the past?
 
BUTLER: No, this is a red herring, Sonya. It really is. The figures that I've talked about, the calculations that we've made, and we've sent out to every single general practice for them to examine and kick the tyres on are based on the existing practice. The existing practice has four patients per hour. That is the basis of our calculations. The earnings calculator that I talked about was based on 15-minute consultations on average. I know there's this thing going around that this is going to create six-minute medicine, that is a red herring. We've based all of our calculations on exactly what GPs are doing right now. There's no need for them to change their practice and to rush patients through in order to get an advantage from this funding. The funding will advantage them if they just keep doing what they're doing now.
 
SCHILLER: Doctors are saying that if you ever turn up for an appointment, they're rarely on time, so they don’t push patients through as quickly as you might claim. And they also say their time is taken up with things like admin and paperwork. So the modelling that you have provided that assumes they're going to earn over 400,000 a year is incorrect. How would you respond?
 
BUTLER: I'll just say again, I'm using the earnings calculator they use. I agree we need to cut down on paperwork in general practices. In health generally, it frankly is the one sector of the economy that has been the slowest to take up digital operations. There's still so much paper being used in general practices and other healthcare settings. About 70 per cent of the country's fax machines are used in health still. There's a lot of work to do.
 
SCHILLER: I've always wondered that. Why are they faxing? Have you ever wondered that? I always wonder that.
 
BUTLER: It drives me to distraction. If I've got one ambition as Health Minister, it's get rid of the fax machines and get people using digital technology. They are starting to take up some of these AI tools to take notes and to record that electronically. There's lots to do there. But it's another red herring. I know there are doctors and there are doctors' groups who will push back against what is the biggest investment in Medicare in its history. But these are just red herrings. This is a genuine offer designed to turn around a situation that has been in place for years with a declining bulk billing rate. And as a Labor Government, bulk billing is the beating heart of Medicare for us. We will do everything we can to turn that around.
 
FELDHOFF: We've got some calls to get to and we'd love you to take them. But just before we do, a doctor on our text line has come back and said you are incorrect, Minister, saying the data shows six minutes is reimbursed three and a half times more than 20 minutes. Can you comment on that?
 
BUTLER: That's just a statement of the existing Medicare schedule. This red herring that us trying to invest more in bulk billing is going to lead to a change in practice is a red herring. We have based our funding on what doctors currently do now, you know, the earnings calculator I talked about based on what they currently do now. To pretend and raise this suggestion that what I'm trying to do is push people into six minute medicine is complete rubbish.
 
SCHILLER: Cherie is a GP from the Hills. Cherie, you've been hearing the Health Minister, Mark Butler, outline the changes that will happen on 1 November. Do you think this will incentivise you to bulk bill?
 
CHERIE, CALLER: Absolutely not. The 15 minutes may be an average, but a lot of practitioners work with complex, multi-morbid patients with mental health issues with a timescale of taking 30 to 45 minutes per consult. There's no four an hour in that. And that particular sort of medicine under Medicare schedule is rebated at about a third, so $2 to $3 a minute compared with $7 a minute for the average consult. That is still way, way beyond, not even taking into account the complex administration that goes with complex patients in terms of communications with hospitals, disability support, pensions. None of this is paid. This is all done either as part of the consult or, let's be honest, when I go home.
 
SCHILLER: So he said that he's used existing data for these calculations. You're saying that doesn't gel with your reality?
 
CHERIE: It certainly doesn't gel with my reality. And if I were to bulk bill, I would have to practise six minute medicine to make anything like a satisfactory income. So I'm going to need to keep charging people who can afford it private fees. We already do bulk bill those we can, which is often people with pension cards, et cetera. But, you know, having to write a report that takes three hours, which we can't charge for, I don't know where that gets calculated into the thing, which is why a lot of GPs, I have to work away from home a certain number of times a year in an Aboriginal service which pays by the hour, and I think, just subsidise the work I do in private practice. I don't want to give up private practice.
 
FELDHOFF: Yeah, Cherie, look, thank you for that. Zoe is in Eudunda. Hello, Zoe.
 
ZOE, CALLER: I would just like to propose to the Minister how bizarre this all sounds to people living in regional areas. We, our local practice and lots of practices around the Mid North do not offer bulk bill and then we're charged a $10 site fee on top of our fee and also if we have to go to an emergency service, like the Kapunda Hospital, for example, we are charged a fee and seen by a GP, and it's $70 to go to an emergency section. I think the people in the regions are being forgotten in this.
 
FELDHOFF: Well, let's go back to the Minister, because my understanding is the incentives are higher for those doctors in regional areas, so you may be seeing more of it in future, Zoe. Is that right, Minister?
 
BUTLER: That is right. The incentives increase the further away you get from the general post office. They're really quite significant into some of the small and medium-sized rural towns. And GPs, if they fully bulk bill, will earn considerably more than their equivalent in the major cities. But your caller, Zoe, is right to say that currently only about a quarter of fully bulk billing clinics are outside of our major cities. Three quarters are in the big cities, only a quarter of them are in country Australia. But almost half of the clinics who've told us that they're charging a gap fee this week and they're moving to fully bulk billing next week are in rural Australia. I think those clinics are starting to recognise, hundreds of them are starting to recognise these incentives are especially attractive for rural clinics.
 
MCCLAREN: Raj is a general practitioner from Salisbury and has a question about bulk billing and mental health. Good morning, Raj.
 
RAJ, CALLER: My question, there are two questions. One is with this universal bulk billing, the Minister will be aware that it is being forced that these are the item numbers, there are probably hundreds of them, that have to be bulk billed if a practice is taking over this. Why is it that a triple incentive is not paid on all of those items and only a handful of consult items? And my second is, why there is no triple incentive on mental health items? If a person comes for a mental health plan, there is no triple incentive. So is the Minister not serious about mental health?
 
SCHILLER: Raj, we're running out of time, but let's put that to Mark Butler. We've heard mental health consults a couple of times lately, Mark Butler, especially the time it takes, and the incentives provided. How would you respond?
 
BUTLER: Raj talks about a mental health plan, but most work that GPs do around mental health is done as a general consult. It's probably the biggest part of GPs' work, they tell us, and they do it through their usual consults, whether that's a short, medium or long consult, and the bulk billing incentive will apply to those. We know that that's important. As a former Mental Health Minister, I'm very passionate about that.
 
But I just want to say, even if a practice doesn't decide to become a 100 per cent fully bulk billing practice, the investments that kick in on Saturday will still benefit them because I know most GPs will still be bulk billing people who don't have a concession card, people who are obviously on relatively low incomes but not below the threshold that gives them the card. At the moment, GPs are bulk billing those people very regularly and they're getting nothing for it. From Saturday, they'll actually get some recognition for the fact they lean in and bulk bill some of those Australians. Even if they choose not to go 100 per cent, which obviously I'd love them to do, they'll still get a benefit from this investment.
 
FELDHOFF: Federal Health Minister Mark Butler, thank you for your time today.
 
BUTLER: My pleasure.
 
FELDHOFF: Those changes come in on Saturday, so GPs will be starting to make their decisions around that from Saturday.