Objective: To identify factors affecting bulk-billing by general practitioners in Australia.
Design, participants and setting: A community-based survey was administered to Australians aged 16 years or older in July 2013 via an online panel. Survey questions focused on patient characteristics, visit characteristics, practice characteristics.
Main outcome measures: Factors associated with GP bulk-billing.
Results: 2477 respondents completed the survey, of whom 2064 (83.33%) reported that the practice that they went to for their most recent GP visit bulk billed some or all patients. Overall, 1763 respondents (71.17%) reported that their most recent GP visit was bulk billed. Taking into account the duration of visits and the corresponding Medicare Benefits Schedule rebate, the mean out-of-pocket cost for those who were not bulk billed was $34.09. Results of a multivariate logistic regression analysis suggest that the odds of being bulk billed was negatively associated with larger practice size, respondents having had an appointment for their visit, higher household income and inner or outer regional area of residence. It was positively associated with the presence of a chronic disease, being a concession card holder and having private health insurance. There was no association between bulk-billing and duration of GP visit, age or sex.
Conclusions: Our results indicate that there are associations between patient characteristics and bulk-billing, and between general practice characteristics and bulk-billing. This suggests that caution is needed when considering changes to GP fees and Medicare rebates because of the many possible paths by which patients' access to services could be affected. Our results do not support the view that bulk-billing is associated with shorter consultation times.
- 1. Department of Health. Quarterly medicare statistics. http://health.gov.au/internet/main/publishing.nsf/Content/Quarterly-Medicare-Statistics (accessed Apr 2014).
- 2. Hopkins S, Speed N. The decline in ‘free' general practitioner care in Australia: reasons and repercussions. Health Policy 2005; 73: 316-329.
- 3. Savage E, Jones G. An analysis of the General Practice Access Scheme on GP incomes, bulk billing and consumer copayments. Aust Econ Rev 2004; 37: 31-40. doi: 10.1111/j.1467-8462.2004.00306.x.
- 4. Khan A, Hussain R, Plummer D, Minichiello V. Factors associated with bulk billing: experience from a general practitoners' survey in New South Wales. Aust N Z J Public Health 2004; 28: 135-139.
- 5. Jones G, Savage E, Hall J. Pricing of general practice in Australia: some recent proposals to reform Medicare. J Health Serv Res Policy 2004; 9 Suppl 2: 63-68.
- 6. Australian Bureau of Statistics. Australian health survey: first results, 2011–12. Canberra: ABS, 2012. (ABS Cat. No. 4364.0.55.001.) http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0012011-12?OpenDocument (accessed Jan 2014).
- 7. Schoen C, Osborn R, Squires D, Doty MM. Access, affordability, and insurance complexity are often worse in the United States compared to ten other countries. Health Aff (Millwood) 2013; 32: 2205-2215.
- 8. Australian Bureau of Statistics. Patient experiences in Australia: summary of findings, 2012–13. Canberra: ABS, 2013. (ABS Cat. No. 4839.0.) http://www.abs.gov.au/ausstats/abs@.nsf/mf/4839.0 (accessed Jan 2014).
- 9. Australian Bureau of Statistics. 2011 Census QuickStats. http://www.censusdata.abs.gov.au/census_services/getproduct/census/2011/quickstat/0?opendocument&navpos=220 (accessed Jan 2014).
- 10. Doiron D, Jones G, Savage E. Healthy, wealthy and insured? The role of self-assessed health in the demand for private health insurance. Health Econ 2008; 17: 317-334.
- 11. Medibank. Medibank and IPN trial to give members more options to access to GPs at no cost [media release]. 10 Jan 2014. http://www.medibank.com.au/About-Us/Media-Centre-Details.aspx?news=535 (accessed May 2014).
- 12. Day SE, Alford K, Dunt D, et al. Strengthening Medicare: will increasing the bulk-billing rate and supply of general practitioners increase access to Medicare-funded general practitioner services and does rurality matter? Aust New Zealand Health Policy 2005; 2: 18.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.