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May 18 2011

Bulk Billing Doctors in Australia

Bulk Billing in Australia

A quick definition of Bulk Billing is where the Doctor charges the Government for your medical care, and you pay nothing.

You will find some locations where most doctors will Bulk Bill, and other areas where few doctors will bulk bill.

In the cheaper areas of Western Sydney, almost all doctors bulk billed, but in the more expensive areas of Sydney, very few doctors would consider it.

Due to recent legislation, we are now finding that more doctors are bulk billing for Children and Pensioners, due to financial incentives from the government for the Doctors to do this.

Medicare will normally cover the following:

  • 100% of the Schedule fee for GP services
  • 85% of the Schedule fee for other out-of-hospital services
  • 75% of the Schedule fee for in-hospital services
  • The Schedule fee is a fee for service set by the Australian Government and not what your doctor charges you.www.medicare.gov.au/

If a Doctor fully bulk bills, they will not charge you, but they will get paid all of the scheduled fee direct from the Medicare.

Some Doctors wish to charge, say $50.00 or more, so one of two things happens:

  1. The doctor will charge you say $50, and YOU claim 100% of the scheduled $33.55 fee back from the local Medicare Office. Net cost to you = $16.45
  2. The doctor collects $16.45 from you, and gets you to sign the Medicare benefit over to them, and they claim the $33.55 direct from Medicare. Net cost is the same.

This difference is called “A Gap”

More very recent legislation is putting a limit on the maximum “Gap” that you have to pay each year. ie: Once you have paid a certain figure, Medicare will step in again, and repay more of the doctors bill to you. I don’t have full details to hand.

When someone visits a Specialist, Medicare will pay 85% of the Medicare Schedule fee for services provided by the treating practitioner. Let’s say that the specialist performs a Category “C” Consultation for which the “scheduled fee” is $73.75, but charges you $150. You end up paying the difference between the $150 and the Medicare rebate of $73.75 ie: $76.25

Public Hospitals don’t charge anything for Medicare patients, and sometimes even give you free medicine !!

GP Bulk Billing Rates for Australia

1994-95 77.5%
2004-05 75.1%
2014-15 83.0%

Bulk Billing Doctors House Calls

Family Care Medical Services

Family Care Medical Services provides after hours doctors house calls in South East Queensland as well as in North and West Sydney.
Doctors after hours house calls start from 6 pm from Monday to Friday and cease at 8 am the following day.
Saturday services commence at noon.
House calls are available all day and night on Sundays and gazetted public holidays.
www.familycare.com.au

There is a fee for the consultation if the patient does not attend to General Practices which subscribe to the service.
The minimum fee for a standard consultation after 6 pm is $165 and after 11 pm is $185. (as at Dec 2010)
Medicare will refund $120.30 before 11 pm and $141.75 after 11 pm. (Subject to annual changes)

Patients of subscribing General Practices that are concession card holders (i.e. pension, health care card, DVA gold card), a child under 16 years or a Family Care Friendly Society member or a nursing home resident will be bulk billed.

Family Care Friendly Society
www.familycarefriendlysociety.com.au/
Family membership $42.50 per year
Covers the member and spouse, children under 18 years, full-time dependant students 18 years to 25 years, parents over 75 years and permanently disabled children of age living in the member’s household.

Links:

Bulk Billing Statistics 2008

In the December quarter of 2008 a total of 53.7 million Medicare services were bulk billed and 21.7 million of these were GP attendances with 79.0% of all GP attendances overall being bulk billed.

This varied in each State as follows:

Bulk billing figures for GP attendances in the December quarter 2008

  • 84.5% New South Wales
  • 79.4% South Australia
  • 77.3% Victoria
  • 76.9% Queensland
  • 73.6% Tasmania
  • 72.4% Western Australia
  • 61.9% Northern Territory
  • 50.6% Australian Capital Territory

Bulk billing figures for GP attendances in the March quarter 2010

  • 84.2% NSW
  • 79.2% QLD
  • 78.4% SA
  • 78.4% VIC
  • 74.8% TAS
  • 72.5% WA
  • 66.1% NT
  • 47.0% ACT

Bulk Billing Statistics from:

Some earlier examples of GP Bulk Billing rates:

  • 10 Feb 2006 … The national GP bulk-billing rate increased to 75.1 per cent (www.health.gov.au)

November 10, 2007 … the rate of bulk billing by GPs, has dipped by 0.2 per cent of services to 78 per cent nationally. (www.smh.com.au)

2009 Medicare Rebate figures:

Scheduled rebates for Surgery Consultations at consulting rooms

  • Item 3 (Professional attendance for an obvious problem characterised by the straightforward nature of the task)
    Scheduled Fee: $15.35
    Benefit: 100% = $15.35
  • Item 23 (under 20 minutes)
    Schedule Fee: $33.55
    Benefit: 100% = $33.55
  • Item 36 (at least 20 minutes)
    Schedule Fee: $63.75
    Benefit: 100% = $63.75
  • Item 44 (at least 40 minutes)
    Schedule Fee: $93.80
    Benefit: 100% = $93.80

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4 comments

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  1. Chan

    I believe bulk billing by docters would be a great start in promoting better primary health care here in Australia, especially in ‘low-income’ areas and it’s a start in addressing the social determinents of health

    1. ABCDiamond

      I have found it to be very good, and in my 20+ years here have been bulk billed on all but about 3 times, by the local GP’s.

      The more affluent areas tend not to have as many bulk bulling doctors, but the ‘low-income’ areas do tend to be reasonably well catered for by the Bulk Billing System.

      The changes over time:
      24 Jun 2003 … 68 per cent of doctors bulk bill.
      10 Feb 2006 … The national GP bulk-billing rate increased to 75.1 per
      cent.
      and for the quarter ended:
      Dec 2011 … 79.8% of national GP appointments were bulk-billed.

      NSW had the highest bulk bill rate at 85%.

  2. Dr I D Clark PhD

    What financial incentives does the government give medical practitioners to bulk bill?

    1. ABCDiamond

      A good question. I don’t really think that a Doctor gets much in the way of incentives, other than maybe more customers, as the patient does not have to pay anything. I did hear that a small extra fee was given for certain groups of patients being bulk billed, like children.

      In general though a bulk billing doctor will see more patients, but for a smaller fee, although a number of these patient visits will not be complex ones.
      eg: A patient with a cold may not see a doctor if they have to pay themselves, but a bulk billed patient has nothing to stop them visiting the doctor, it is after all… free. I would never go to a doctor for a cold though, I always have the FLU ! 😉

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