A new report on bulk billing has seen the Health Minister claim record rates, while Labor says the cost of health care is spiralling out of control
The report, from the Australian Institute of Health and Welfare (AIHW), showed that half of Australian patients pay a contribution to non-hospital Medicare services.
However the proportion of patients that have out-of-pocket costs and the amount they pay varies greatly according to where they live, warns the report.
The report looked at health services delivered outside of hospitals and subsidised by Medicare, including GP, specialist, imaging and obstetric services, but not services that were paid for completely by the patient or subsidised by private health insurance.
It found that governments contributed $19 billion towards these services in 2016–17, and $3 billion was paid for by patients.
Nationally in 2016-7, half of patients (10.9 million people) spent some of their own money on their services, while the remaining half had the entire cost of non-hospital Medicare services covered by the government.
The AIHW says that this is different from the usually reported bulk-billing rate for GP services that were completely paid for by the government. In 2016–17, 86% of GP services were bulk-billed while 66% of patients had all of their GP services bulk-billed.
In the Northern Territory, 31% of patients had out-of-pocket costs, while in the ACT the figure rose to 69%.
Patients in metropolitan areas were less likely to have out-of-pocket costs than regional patients.
“For patients who incurred out-of-pocket costs, the median amount each patient spent in the year was $142—but patients living in some PHN areas paid almost double that of others,” said AIHW spokesperson Michael Frost.
The median out-of-pocket cost per patient during 2016-17 ranged from $104 in Western Queensland to $206 in Northern Sydney.
For the 10% of patients with the highest costs, there was also substantial variation across similar socioeconomic areas. For example, among patients living in lower socioeconomic areas in the major cities, the top 10% in Playford, SA, were out-of-pocket at least $372 during 2016‒17, while those in Botany (NSW) were out-of-pocket at least $682.
The report also highlights variation in how much patients pay out-of-pocket per service. More than seven in 10 people who had specialist consultations had out-of-pocket costs, and for these people the median gap per specialist visit was $64. Across local areas, the median out-of-pocket cost ranged from $36 to $97 per specialist service.
Health Minister Greg Hunt said that this meant a record number of Australians were visiting their doctor “without having to pay a cent”.
“The data for the 2017-18 financial year shows an increase of more than 5.7 million free services compared to last year, boosting the national bulk-billing rate to 86.1 per cent for the first time in Medicare’s history,” he said.
“This is nearly 4% higher than Labor’s 82.2 per cent rate, which they achieved when they were last in Government.
“Medicare funding is at record levels and the comprehensive data released today shows more Australians are seeing their doctor without having to pay than ever before.”
But Shadow Health minister Catherine King had a different view.
“The cost of health care is spiralling out of control under Malcolm Turnbull, with a new report completely demolishing the Government’s claims around Medicare bulk billing rates and out-of-pocket costs,” she said.
“After four years of the Abbott-Turnbull Medicare freeze, the Australian Institute of Health and Welfare report has finally laid bare the full extent of the health affordability crisis in Australia.
“As a result of these soaring costs, 1.3 million people are either delaying or skipping seeing a doctor or getting a test when they need to – putting their wellbeing and possibly even their lives at risk.
“The report also exposes Greg Hunt’s bulk billing lies. The data shows only 66% of patients are bulk billed by their GP – a far cry from the 86% figure the Minister trots out on a daily basis.”
The Australian Healthcare and Hospitals Association have confirmed the figures cited by Mr Hunt as “misleading,” she said.
“That’s a nice way of saying they are a complete con-job and totally meaningless.”
AMA president Dr Tony Bartone said that the figures showed the “impact” of several years of freezing Medicare patient rebates.
“The Medicare rebate has failed to keep up with the increasing costs of providing medical services,” Dr Bartone said.
“While bulk billing in general practice remains high, it does not paint the full picture. Only around two-thirds of patients have all their visits to a GP bulk billed.”