In reply: We thank the authors of these letters for raising many of the complex issues that underlie the current geographical inequities in costs of general practice consultations.

Ruse is concerned that we did not point out the inadequacy of the current Medicare rebates to practitioners. An appraisal of the adequacy of Medicare Benefits Schedule fees was beyond the scope of our study. We presented data on the out-of-pocket costs of general practice consultations, according to demographic and health-related characteristics of consumers, for consideration by all interested parties — practitioners and patients.

As suggested by Harrison, we could also look at differences in bulk-billing and costs by State and Territory. However, as Medicare rebates are a Commonwealth issue, looking at national data seemed a sensible first step. We cannot examine total costs of healthcare, as the Medicare data do not include all costs related to care.

Arnold argues that "affordability" should be better defined by us and questions, "how unaffordable is an occasional $5–$10 out-of-pocket fee for a GP consultation?". We have three responses. Firstly, many medical practices require an "up-front" payment. As written by one older respondent living in a rural area, "Small country town medical clinics do not give bulk-billing to aged pensioners and insist on cash payment on the day of the visit . . . many pensioners would not seek medical help when needed if at the time no cash was available". Our second response is that, regardless of how "affordability" is defined, the issue is one of equity. Is it reasonable that a major factor identified in our study as influencing access to bulk-billing is whether you consult a practitioner in an urban area or a rural area? Finally, "affordability" can only be assessed in relation to income and other expenditure and commitments. In our surveys we ask women how satisfied they are with the costs of GP care and, while the responses are subjective, they are likely to take into account these contextual issues. These data have not yet been fully analysed.