It probably won't come as a surprise to anyone here that the bulk billing rate for GP non-referred attendances has fallen over the last few years. For a long time, the bulk billing rate was quite stable. Just before the COVID-19 pandemic, it was hovering around 85%.
It spiked during the COVID pandemic due to several reasons, not least being a short-lived requirement to bulk bill all temporary telehealth services. But over a two-year period since the pandemic ended, it's declined by about 10 percentage points to a low of around 75% in October of 2023, which is just before the new bulk billing incentive items were introduced on 1 November. Since then, the bulk billing rate has stabilised and it started to rise slightly, but it hasn't recovered to previous levels.
During the decline in bulk billing rates, many general practices shifted from a fully bulk billing model to a mixed or private billing model. You can see our categorisation of that down the bottom [of the chart] there. As you can see, since 2020, the number of practices that bulk bill all of their services have nearly halved from about 55% to just under 30%, 29%.
At the same time, the proportion of practices bulk billing less than 50% of their services has tripled, albeit from a low base. It's important to note that those mixed billing practices, which make up 60% of all practices this year, still bulk bill over 75% of their services.
The reduction in bulk billing has caused total patient out-of-pocket costs to jump significantly. In fact, it's more than doubled over the last 3 years from $780 million in 2020-21 to nearly $1.7 billion in 2023-24. You can see it's been very flat over quite a long period of time before that.
The latest financial year’s data hasn't been published yet, but I can say that this year's figure is higher still.
It's having a measurable impact on patient access to GP services. Every year, the Australian Bureau of Statistics publishes a fantastic report called ‘Patient Experiences in Australia’ which is based on a very large, very detailed survey. One of the questions they ask is whether, over the last year, the respondent has delayed or did not see a GP due to cost.
As you can see in the chart on the left, the proportion of people deferring GP care due to cost had hovered between 3.5% and 4% for quite some time, the low point during COVID. Over the last 2 surveys, the proportion has more than doubled from 3.5% to 8.8%.
It's working-age Australians that are most affected by this. As you can see on the chart on the right, less than 2% of older Australians are avoiding GP care due to cost. That number is as high as 15% for people aged 25 to 34, and that proportion has more than tripled over the last 2 years.
That's not to put blame at anyone's door, it's just to provide a little context for the investment in bulk billing generally, and for the focus on clinics that give patients who need it an option to receive bulk billed care.