NIKOLAI BEILHARZ, HOST: A survey by the private company Cleanbill has found that Australia's bulk billing rate has dropped to 20.7 per cent at the start of this year, down from 35 per cent 2 years earlier. But that's been disputed by the Federal Health Minister, Mark Butler, and he joins us now. Minister, thank you for your time this afternoon.
MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: My pleasure.
BEILHARZ: So what is your response to the study saying bulk billing rates have dropped and it is a significant drop?
BUTLER: This is a private company that essentially does a ring around to general practices and asks them, as I understand it at least, “do you bulk bill every single patient that comes into your practices?” We do something different. What we are able to do as the government is we have access to every single Medicare billing. I started this a couple of years ago, we now publish very regularly the percentage of GP visits that are bulk billed. We do that nationally. We do it by state and we break it down by federal electorate as well. We're now able to very transparently track the amount or the number of visits to your GP that are bulk billed. We were particularly keen to do that because when we came to government, bulk billing was in “freefall”. That was the language the College of GPs used, not mine. They said to us that general practice was at a tipping point because literally billions of dollars had been ripped out of it in the previous decade through a freeze to the Medicare rebate that went on for 6 years. It was initiated by Peter Dutton when he was Health Minister. We then started reporting much more transparently what's happening, and also made a huge investment in bulk billing in the 2023 Budget.
BEILHARZ: This company says it's 20 per cent, what are you saying?
BUTLER: We can say very authoritatively it's about 77 per cent.
BEILHARZ: That's a big difference.
BUTLER: It depends what you're measuring. They're measuring the number of practices who bulk bill every single person that comes through their front door, whether that's Gina Rinehart or James Packer or whether it's an aged pensioner or a 12-year-old child. What we do is we track every single GP visit that happens over a given 3-month period, and we report the percentage of those GP visits that are bulk billed and the percentage that attract a gap fee. What we've found is since the investment we made the year before last, it's been running for about 13 months now, the freefall that was happening in bulk billing, literally, it was falling off a cliff, the rate of bulk billing that’s stopped. And really pleasingly bulk billing has started to increase again in every single state and territory. Indeed, in South Australia last year, bulk billing went up by about 4 per cent. It went up around from around 70 per cent to around 75 per cent, which was one of the highest increases in the country. It delivered an additional half a million free visits to the doctor that otherwise wouldn't have happened.
What we've invested really, in partnership with the College of General Practitioners, is starting to make a meaningful difference but we know there's more to do. We know it's still too tough to find a bulk billing doctor in Australia. I want there to be more free Medicare services. When he was the Health Minister, Peter Dutton very famously said there were “too many free Medicare services,” which is why he tried to abolish bulk billing altogether. For us as a Labor Party, bulk billing is the beating heart of Medicare. We want to see it increase which is why I've said, of course, there is more that we will be talking about as we move into the election campaign.
BEILHARZ: I'll be keen to hear from you this afternoon as well. You've just heard the Federal Health Minister, Mark Butler, saying bulk billing rates are on the increase. Is that what you found when you've headed to the doctors? Minister, when it comes to that rise in bulk billing, is it right to say, though, that it's not spread across demographics? It's on the rise but for people who are eligible for that extra funding in the elderly, children, concession cardholders, but the people in the middle, if I can put it that way, are not seeing a similar rise?
BUTLER: That's spot on. The bulk billing incentives, the additional money that we as a government pay GPs to bulk bill is particularly for pensioners, for concession cardholders and for children under the age of 16. One of the discussions we've been having over the last couple of weeks is the fact that although bulk billing rates appear to have stabilised for adults between the ages of 16 and 64 who don't have a concession card they're still doing it tough finding affordable access to a GP, and that's something I'm turning my mind to. We've succeeded in our first job, which is to stop the slide in bulk billing across the country. We did that with a huge investment of billions of dollars into bulk billing. That's also led to some increase in bulk billing but I want to do more. I want to do more to strengthen Medicare. When I came to government as the Health Minister, I, tried to be as honest as I could with the Australian people and say, we can't fix a decade of cuts and neglect in one term of Parliament. We need more time to set Medicare up to be what the Australian people want it to be, which is having as much bulk billing as possible, having it as easy as it can be to find a doctor when you need it. Finding new models of care, like the Urgent Care Clinics that we've been rolling out across the country now as well.
BEILHARZ: Jane on the text line says “Mark Butler is talking about consultations, not people. It's clear that people who are not bulk billed cannot afford to see GPs regularly. Thus, those who are bulk billed go more often than those who are not bulk billed.” Do you worry about that? People who would not bulk billed are not going to the doctor because they can't afford it?
BUTLER: Jane's spot on. At a time where people's household budgets are under pressure, I really worry that people are being forced into positions about whether or not they go to the doctor or whether they get a script filled at the chemist that their doctor has said is important to them. That's why we focus so heavily on making medicines cheaper. Our biggest investment in cheaper medicines was focused on people who don't have a concession card. People who are earning a wage but are still doing it tough. We know they were making pretty difficult choices between medicines that their doctor wanted them to take on the one hand, and other household goods like groceries. It is something I worry about. Jane is right to point to that group in the population, and that really is the group we're starting to think about now. We think we've turned things around for the lowest income people in the country, people on the pension, people on concession cards, but there is another group in the population that I'd like to see find it much easier to access a bulk billed doctor than they can necessarily today.
BEILHARZ: We're talking about the rates of bulk billing appointments here in Australia. Mark Butler is with us, the Minister for Health and Aged Care. Also with us, Senator Anne Ruston, the Shadow Minister. Anne Ruston, thank you for your time this afternoon.
SENATOR ANNE RUSTON: My pleasure. Thanks, Nikolai.
BEILHARZ: So you've heard Mark Butler there say, well, look, you've got to look at the overall number of Medicare appointments overall, not just ring a clinic and say do you bulk bill everyone. Does that have a point that you've got to look at the data in its entirety?
RUSTON: Well, you do have to look at the data in its entirety, but the same story is being told by the Department of Health. The same story is being told by the Health of the Nation Report from the RACGP that we have seen a significant drop in bulk billing rates under the watch of this government. In fact, the reality is that it was up to 12 per cent. Mark Butler is somehow claiming some great achievement because he's got it back to 11 per cent. I mean, the facts speak for themselves that the people that we really need to be asking are the Australians out there who are seeing very little improvement, if any improvement at all, after seeing a catastrophic collapse in bulk billing, a catastrophic increase in out-of-pocket expenses under this government.
But what I'd say is that let's stop the spin. Let's look at the facts, and let's start addressing the issues that are facing Australians at the moment, because Australians are hurting at a time right now and they need some help while they're struggling. But I also would take some level of offence to the fact that the Minister is happy to flat out lie to your listeners. I mean, he just made the comment that the freezing of the indexation happened under Peter Dutton. It did not. It happened under Tanya Plibersek, who was the Health Minister in the previous Labor government. He also made the comment that the bulk billing was free falling when he came into government. The free falling started under this government. Now I don't want to go for a he-said she-said. That does not help Australians, hardworking Australians out there who are struggling to pay to go to the doctor or are struggling to get an appointment. And I want to work constructively to make sure Australians do that. But I also want to make sure that we have the facts on the table and we're telling the truth.
BEILHARZ: So what would you do?
RUSTON: Well, I think the first thing we need to do is we need to be honest about what really is happening out there. Australians are really struggling with health care. It's never been harder or more expensive to see a doctor, as you rightly point out. People are avoiding going to the doctor because they say they can't afford to. And what ends up happening is they get sicker and then they end up having to turn up to emergency departments because their situation gets critical. And that's why we're seeing ramping and our hospitals in the state that they are at the moment. So I think we need to be honest about where we are at the moment and then actually look constructively about how are we going to address that. And we clearly, there is one really big issue that everybody is avoiding talking about and that is the crisis in workforce. We simply do not have enough doctors. Um, we know that we need probably another 8,000 doctors in Australia to meet the demand that we're going to need over the next few years. And we just simply are not seeing enough of our medical graduates choosing to become general practitioners. They're choosing other specialities in medicine. And I think the most important thing that we need to do now, if we really are going to make a change and get people to be able to get access and affordable access to the doctor, we need to have the doctors that are there so that they actually, when they ring up, they can get an appointment.
BEILHARZ: Mark Butler can I return to you, on that note of how many people are choosing to specialise as GPs and also a person on a text line, making a somewhat related point about increasing the number of medical school places for Australian children to become doctors.
BUTLER: Anne is right to point to that issue, which is why I'm so pleased that over the last couple of years, we've been able to get 17,000 new doctors into the health system in two years. That's the biggest increase in more than a decade. What particularly pleases me is we've started to see more medical graduates choose general practice as a speciality as a profession. That number is up by about 25 per cent over the last couple of years as well. It reflects the fact that general practice is now much more valued in the debate around health. The Health of the Nation Report that Anne referred to, it's the survey by the College of General Practitioners of their own members. It found, first of all, that more GPs are bulk billing more of the time than they were the previous year. But really, pleasingly, it found that GPs are happier at work, and it found that GPs are more likely now to recommend general practice as a career to junior doctors as well. Now we've got a long way to go. We do have a big number of doctors to recruit over coming years, as Anne has said, but we are making some inroads into that. What particularly pleases me is we are starting to see that decline in the number of medical graduates who want to go into general practice start to turn around as well. Green shoots of recovery. We've got much more to do. But I think that is heading in the right direction for the first time in quite a while.
BEILHARZ: Mark Butler, thank you for your time this afternoon.
BUTLER: Thanks, Nikolai.
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