To the Editor: Young and Dobson’s article1 examining the bulk-billing status of services provided to women generated much debate.2,3 To add to that debate we undertook an analysis of 5546 Medicare-claimable general-practice encounters. Data were provided by 200 general practitioners between May and July 2002, using the BEACH (Bettering the Evaluation and Care of Health) methodology.4 We examined which encounter, GP and patient characteristics determine billing status (patient-billed or bulk-billed). From time and day of service we determined which consultations were “after hours”.

Over two-thirds of services (69.8%; 95% CI, 65.4%–74.3%) were bulk-billed. One in fourteen services (7.1%; 95% CI, 2.2%–12.1%) were delivered “after hours” as defined by the Australian Government Department of Health and Ageing5 (ie, between 6 pm and 8 am on weekdays or between 1 pm Saturday and 8 am Monday on weekends). The results after simple and multiple logistic regression analysis are shown in the Box.

After-hours consultations were significantly more likely to have been bulk-billed than those held during standard office hours (odds ratio [OR], 1.9).

Patients aged < 15, 15–24 years and > 75 years were significantly more likely to be bulk-billed than working-age adults (P < 0.0001).

Also significantly more likely to be bulk-billed were patients from non-English-speaking backgrounds (OR, 7.3), living in an urban area (OR, 2.6), holding a healthcare card (OR, 3.5) and/or coming from a low socioeconomic status background (OR, 2.3).

There was no significant association between the likelihood of being bulk-billed and the age or sex of the GP, the practice size or the number of problems managed at the encounter.

Interestingly, the variable with the largest impact on bulk-billing rates was whether patients were from a non-English-speaking background. These patients were over seven times more likely to be bulk-billed than patients from an English-speaking background.

This study adds further support to the findings of Young and Dobson1 that patients in urban areas were significantly more likely to be bulk-billed for general practice consultations than their rural counterparts. We can go one step further and say that consultations given after hours were also significantly more likely to be bulk-billed. The conclusion is that bulk-billing decisions by GPs are not uniformly influenced by timing, location and patient characteristics. This has implications for assessing the likely impact of bulk-billing strategies such as MedicarePlus.6