Patients charged expensive out-of-pocket fees as doctors stop bulk billing

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Perth mother Jayme Lees has been bulk billed by her GP for the past six years, but when she took her newborn son for a check-up in June she was hit with a hefty, unexpected fee. 

“I went to leave when they told me there was a cost … I was quite shocked,” she said.

Some of her son’s fortnightly visits to the GP incur a $60 to $80 out-of-pocket fee, adding pressure to the family budget that relies on one income. 

“It has been hard because groceries have gone up, the price of living, and the fact that now [we’re not] bulk billed with doctors, it does make it a lot harder,” she said.

“Now we just have to be a bit more mindful with spending, and if we do have an appointment coming up, we just have to make sure we account for it.”

Mid-shot of Jayme Lees with her baby on her lap
Jayme Lees says she waited two weeks to get a GP appointment for her son. (ABC News: Tabarak Al Jrood )

The 26-year-old is also concerned about the state’s doctor shortage after having to wait two weeks before her son Ryder could be seen by a GP for his sinus infection.  

“It does make it a bit scary to think what if he was quite sick and needed antibiotics quite quickly, but he couldn’t get in for two weeks,” she said.

GPs left with no choice  

Doctor Lewis MacKinnon, who treats patients at his Armadale clinic in Perth’s south, is one of many GP clinics across the state that have recently changed their billing model in favour of privately charging patients.

He said the current funding system had become unsustainable.

Mid-shot of Dr Lewis sitting on a chair at his desk
Lewis MacKinnon’s Armadale medical practice has recently started privately charging patients.(ABC News: Tabarak Al Jrood )

“We’re faced with a choice either of seeing increasingly more patients per hour to cover our overheads, or else passing costs on to the patient in the form of a gap payment,” he said.

“Obviously that’s something that goes against our nature, to make it more difficult to access health care, because you now need to consider your economic circumstances,” he said.

“Investing in general practice and preventative health care may not seem particularly sexy, but that’s what saves lives, that’s what prevents admissions, and that’s what improves patient outcomes.

“But at the end of the day, the government hasn’t kept pace with medical inflation, and patients are the ones that are losing out.”

Last month, the federal government increased the Medicare rebate by 1.6 per cent, after it was frozen for more than a decade.

But Dr MacKinnon said that was not nearly enough to cover rising costs.

Dr Lewis, wearing a mask and placing stethoscope on patient's chest
Dr MacKinnon says he is concerned patients will avoid seeing a GP due to the cost. (ABC News: Tabarak Al Jrood )

“Traditionally we tried to bulk bill everybody that attended our clinic,” he said.

“But now we private bill everyone who joins our practice, regardless of income status, because unfortunately we can’t afford to pass on huge discounts, which is really what the government expects us to do with such a paltry Medicare rebate. 

“I worry about patients avoiding getting the help that they need and maybe having a worse clinical outcome.

“And I think the government needs to think very seriously about the role that funding has in that.”

Vulnerable patients losing out 

Emily, 34, relies on regular doctor’s visits to obtain prescriptions for ADHD medication. 

Generic doctor and patient consultation
An increasing number of GPs are moving away from bulk billing. (ABC News: Tim Swanston)

But since moving to Perth two years ago, she has changed GPs nine times after each one stopped bulk billing.

“I don’t have the funds for it … to have that added $100 or so on to my weekly or monthly spend if I needed to see the doctor, it’s been a huge hardship to take on, plus the added stress of trying to squeeze into an appointment,” she said.

Emily said it was disappointing that vulnerable Australians would be left without access to affordable, basic health care.

A sign on the door of GP practice which says "From 1st of June 2022 patients joining the practice will incur private fees.
Doctors moving away from bulk billing say the Medicare rebate is not covering rising costs.(ABC News: Tabarak Al Jrood )

“I’m very passionate about the system that we all contribute to in Australia, and I was under this impression that we’re a country where we pride ourselves on our Medicare and it was something I was quite proud about,” she said. 

“Seeing friends in the US where they don’t have this sort of care and it’s a really burdened system, it’s really sad to say that this is starting to happen here.”

Investment needed to save lives 

Doctor Ramya Raman, the WA chair of the Royal Australian College of GPs (RACGP), said the increasing number of GPs moving away from bulk billing had been a “predicted storm” due to economic pressures.

Mid-shot of Dr Ramya Raman smiling at the camera
Ramya Raman is calling for more investment in general practice. (ABC News: Tabarak Al Jrood )

“We need to be able to retain and attract the best staff that we possibly can. We’ve got utilities, rent, medical supplies [and] medical insurances,” she said.

“We also need to keep up with the inflation rates and the costs that are involved, [but] with the lack of Medicare patient rebate indexation, that hasn’t been happening and it’s been really challenging … it’s got to the point where things are becoming unsustainable.”

WA Health Minister Amber-Jade Sanderson said the issue had added pressure on already stretched emergency departments.

“There is a significant lack of primary health care in WA. It’s around the country but it is particularly acute in WA and if you can’t get access to a GP, you go to an emergency department, and that’s what we’re seeing here,” she said.

WA Health Minister Amber-Jade Sanderson speaks with a puzzled look.
Amber-Jade Sanderson is concerned about the pressure being placed on emergency departments. 
 (ABC News: Keane Bourke)

The federal government has promised to deliver at least 50 bulk-billed urgent care medical centres across Australia over the next four years.

The clinics would be based at GP surgeries and community health centres in at least seven locations across WA to help alleviate the state’s besieged hospital system.

But Dr Raman said more investment into existing general practice was needed.

“Primary care is the bedrock of the health system and having a very strong primary care and a general practice care in a country will ultimately ensure that we’ve got a really healthy population,” she said.

“And as GPs, it is about being valued for what we do.”

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