Radio interview with Minister Butler, ABC Brisbane – 4 November 2025

STEVE AUSTIN, HOST: You heard the Treasurer talk about the Medicare incentive scheme. It kicked in on the weekend. New incentives are meant to encourage GP clinics to increase their bulk billing rates. It’s had a less than enthusiastic take up, as you would’ve heard with me yesterday from the Australian Medical Association. It was a key promise from the Federal Government’s election campaign, the Prime Minister constantly waving the Medicare card, saying it’s not a credit card, it should be all you need to visit the doctor. Mark Butler is Australia’s Health Minister – I spoke to him earlier this morning and asked how many clinics in Queensland have signed up to the new program.
 
MARK BUTLER, MINISTER FOR HEALTH AND AGEING, MINISTER FOR DISABILITY AND THE NDIS: Over 1,000 clinics have already signed up before the new program started. That means there are more than 1,000 clinics across the country that last week were charging gap fees, and this week are bulk billing every single patient that comes through their doors. That includes 200 in Queensland, so last week there were 200 full bulk billing clinics. This week, there’s 400, so it’s doubled the number in just a few days. That number is increasing every single day, and I expect it to for quite some time to come.
 
AUSTIN: The federal government’s target was around about 90 per cent. How long does the Government think it'll take to get to that point?
 
BUTLER: We've had a pretty conservative target of 90 per cent by the end of this decade. We think that there's going to be a big jump in bulk billing pretty much immediately. You get that through the number of clinics that have shifted from gap fees to being 100 per cent bulk billing clinics in just a few days. In addition to that, I'm confident there will be a lot of clinics who, even if they're not bulk billing every single person that comes through their door, will lift their bulk billing rate as a result of the record investment that kicked in on Saturday, 1 November.
 
AUSTIN: My guest is Health Minister for Australia, Mark Butler. Mark Butler, you've tripled the bulk billing incentive, so that means doctors can bulk bill pensioners, concession cardholders and children. Now you've made it across the board for all adults. How does it work practically?
 
BUTLER: It means the GP will get a minimum, base rebate for seeing a patient for a consult. A standard consult, which is less than 20 minutes, will get $43 or thereabouts paid as the base Medicare rebate. If they bulk bill, then in addition to that, they'll get an incentive, which varies depending on whether you're in the big cities or in the region. In the big city, instead of $43, you'd get about $70. In a region, you might get more than $80. So, in the regions, you pretty much double your income from Medicare if you bulk bill a patient.
 
On top of that, if a clinic is bulk billing all their patients, they'll receive for the first time an additional incentive of 12.5 per cent on top of their Medicare income. We calculated those figures very carefully because we have access to all of the billing information that GPs and general practices currently do. We know that based on the investment that rolled out on Saturday, three-quarters of clinics will be better off financially if they take up the offer and become 100 per cent bulk billing clinics. Obviously, their patients will be much better off, but it's better for practices and better for individual doctors as well.
 
AUSTIN: I spoke with Nick Yim from the Australian Medical Association in Queensland yesterday, and he told me this was the core issue for GP clinics.
 
NICK YIM, AUSTRALIAN MEDICAL ASSOCIATION: But the ultimate issue across the decades is the fact that the baseline Medicare rebate has not kept up with inflation, has not kept up with times. And only this will actually increase the incentive to have shorter consultations. And we know that our patients across the country, they're getting older, diseases are getting more complex, and GPs do want to spend that time with the patient.
 
AUSTIN: In other words, they want to be doctors, not production managers, Health Minister Mark Butler. So you heard his comments that the concern is that the incentive is not necessarily going to be what you're hoping it will be?
 
BUTLER: I think that's a bit of a red herring that's often pulled out by the doctors' groups. The first thing I'll say is that in our 3 budgets, we've delivered the three biggest overall increases to the Medicare rebate since Paul Keating was Prime Minister 30 years ago. We have delivered very big increases to the Medicare rebate, the base rebate that the AMA just talked about. But on top of that, our additional record investment has unapologetically been targeted at bulk billing. The doctors' groups did come to me and say, we like the additional investment in Medicare, but we don't want it tied to bulk billing, we just want you to give us the money and trust us to deliver patient outcomes. As a Labor Minister for Health, I just wasn't willing to do that. I said, we’ll put extra money into Medicare because there's nothing more important for our government than that, but we expect patient outcomes. It is unapologetically tied to delivering better bulk billing outcomes for patients.
 
On top of that, this idea that the investment is going to drive shorter consultations is a complete red herring. When I talked about the fact that practices and doctors will be better off, that is based on their existing practice. We modelled the financial impact on exactly what they are doing now, not on any change to practice or more shorter consults. This red herring, I think, just reflects that some of the doctors' groups want us to give the money to them without some patient outcome being tied to it, and I just wasn't willing to do that.
 
AUSTIN: I think the problem for them is it's locked into these defined time periods where- people are complicated, you know? Doctors need to talk with a patient and say, look, what are you thinking? In other words, - it's not a simple, efficient process dealing with people and their illnesses. I spoke with Cleanbill's James Gillespie yesterday. They simply crunched data. This is what he told me yesterday.
 
JAMES GILLESPIE, CLEANBILL CEO: Now, some clinics will make a judgement based on how many more patients they think they can get in the door if they're fully bulk billing or based on state-based initiatives. In New South Wales, bulk billing clinics receive additional tax breaks. So elements like that, but it does make it very difficult to model how many clinics will ultimately take up this change.
 
AUSTIN: You've modelled the change. GP clinics are essentially small businesses, Mark Butler, and so they have to work out if they can get more turnover, i.e. more patients. What does your modelling say? Is that what you're saying, that they'll get more patients through the door at a GP clinic under your new scheme?
 
BUTLER: I come back to that point I made earlier. Our modelling is based on what they're doing right now. It's not modelled on them getting more patients or fewer patients through the door, it's based on the number of patients they've been getting through the door anyway.
 
AUSTIN: Well, here in Queensland, particularly in regional areas, they're actually closing their doors.
 
BUTLER: I think that's a product of whether or not they've got enough doctors, and that's another element to our Strengthening Medicare program. We're bringing a lot more doctors in from overseas, from countries we have confidence in, like the UK, New Zealand and Ireland. We're training more junior doctors as GPs this year than Australia has ever done before, and we'll break that record again next year, so I know we need more doctors and nurses in primary care as well. But coming back to this bulk billing point, a full-time bulk billing doctor a couple of years ago in the city was earning about $280,000 a year after they paid their practice costs. From this week, they'll be earning $415,000 a year, doing exactly the same work, seeing exactly the same number of patients, because of our bulk billing investment. Two years ago, a bulk billing doctor was earning substantially less than someone who was charging the average amount of gap fees. Now they'll be earning a little bit more in the major cities, and in rural areas they'll be earning a lot more. A full-time bulk billing doctor in some of the small rural towns in Queensland will be earning about $490,000 a year, a huge salary increase because of the value we attach to bulk billing.
 
AUSTIN: So do you as Health Minister, Mark Butler, say that this will now stop GP clinics closing in Queensland because you've solved their financial problem?
 
BUTLER: What we've done is made bulk billing a viable financial model for general practice again. We know that there is much more to do in general practice. When I became Health Minister 3-and-a-half years ago, of all the myriad challenges in our healthcare system, particularly after a once in a century pandemic, the one I was most focused on was rebuilding general practice. Because without a thriving general practice sector, the rest of the healthcare system will start to break down. More doctors in it is definitely a priority, and that is really driving why some practices, particularly in country areas, are closing down. We've got a laser-light focus on bringing more doctors in from overseas where we have to fill some of those spots in country Australia, but also training more of our own. I mean, that rate was sliding the number of junior doctors choosing general practice as their preferred career was in freefall when we came to Government. We've turned that back around. New models of care like Urgent Care Clinics. We’ll be rolling another 10 Urgent Care Clinics out over the next few months in Queensland as well, giving free urgent care for people instead of having to line up at emergency department if your urgent care needs don't require a fully equipped hospital.
 
AUSTIN: Mark Butler, Health Minister, is my guest. Before I let you go, can you just clarify something around smoking rates for me? Are smoking rates in Australia going up or down, Mark Butler?
 
BUTLER: They've been coming down for some time. They started to flatline a couple of years ago. We were not on track for our target to get smoking rates down to 5 per cent by the end of the decade, which is why we renewed our tobacco control laws a couple of years ago. We haven't seen any recent data, but I've been pretty upfront that I am worried about the impact that the explosion in illicit tobacco might be having on our smoking rates. We haven't seen official data yet to tell us what exactly is happening out in the community, but we have been down below 10 per cent, which is a huge reduction over a few decades. I am very worried that the biggest threat to the most important public health program we have, which is to stamp out smoking, the biggest threat to that right now is illicit tobacco. We haven't got official data, but I am worried about what the numbers might show.
 
AUSTIN: Are you asking in Cabinet to change the tax or the excise structure around that to try and take the incentive away from organised crime and the sale of illegal tobacco?
 
BUTLER: I'm not convinced that is the right way to go.  The price of illicit tobacco is so cheap, and this is not an Australian problem, we see this in every country really, black market tobacco, that you'd have to effectively drop it by an enormous amount to become competitive, to use that word, with black market tobacco. I think that would have exactly the opposite effect we want, that it would make smoking even more attractive to the Australian population because we know price is a very important tool in the toolbox. The answer to people breaking the law is to enforce the law. That's why we're working so closely with state governments, including Queensland, with policing authorities to track down these criminals that are controlling this market, to bring them to court, to confiscate their profits, to lift our efforts in intercepting these illegal imports at the border. But this is a big fight. The organised criminal gangs that have now taken charge of this market over the last few years see this as a really lucrative source of revenue for them to bankroll things like sex trafficking, cybercrime, drug trafficking and the like. Anyone involved in it, for example, selling it through their shop, should recognise this is not a victimless crime. This is bankrolling some very, very bad people.
 
AUSTIN: Health Minister Mark Butler, thanks very much for your time.
 
BUTLER: Thanks, mate.