By Mikayla van Loon
General practitioner (GP) clinics across Australia have been making the move from bulk billing to private billing, a trend that has started to occur in the Yarra Ranges as costs increase.
Lilydale Doctors and Mount Evelyn Doctors owner Dr Binay Kumar attempted to delay the change from bulk billing to mixed private billing as long as possible but had to make the difficult decision that came into effect as of 1 August to charge $30 per visit.
“Everyone knows inflation has gone up tremendously, everything is more expensive but probably what no one knows is for us Medicare rebates, for GP’s, were frozen from 2014 to 2020,” Dr Kumar said.
“So for six or seven years, we didn’t really have any increase at all in any rebate that we were getting.”
The Medicare Benefits Schedule (MBS) noted the indexation rate as at 1 July 2021 as 0.9 per cent. Dr Kumar said this has now been lifted to 1.6 per cent as at July 2022 but still cannot help cover the ever increasing costs of materials, utilities and wages.
“Over the years, we’ve been absorbing the cost. Every year the living expenses increase, the staff wages increase but our MBS rebates don’t increase for six, seven years,” he said.
“They’ve obviously increased to 1.6 per cent, but the rate of inflation is six per cent. On top of that, under the health professionals award, all the staff were given about 4.5 to 5.1 per cent increase, which is something that we have to give.”
In the last six months alone, Dr Kumar said his clinics have seen a 10 per cent rise in expenses, not even including other services, something that is “unsustainable” without charging a fee.
This was a common response when HealthEd undertook a survey of 500 GP clinics across the country.
Of those clinics 22 per cent had changed their billing model, with one third moving to mixed billing and 67 per cent moving to private billing.
Royal Australian College of GPs (RACGP) president Karen Price said these figures were heading in the wrong direction and unless the government can boost funding to GPs, more clinics will have to pass the fees to patients.
“That is not a decision taken lightly and no one relishes the thought of asking their patients to pay more, particularly those struggling to make ends meet at a time of increased grocery and fuel costs just to name a few,” she said.
“But practices have no other choice because their own costs are rising, and Medicare rebates simply haven’t kept pace with the cost of providing high-quality care. Our hands are tied, we need help desperately.”
RACGP is calling for Medicare rebates to be increased to 10 per cent for a 20 to 40 minute GP visit and for a new item to be included for visits over an hour.
“This will have a lasting impact on the health and wellbeing of people who need to have multiple health conditions carefully managed and result in fewer patients ending up in a hospital bed with a problem that could and should have been managed by their GP,” she said.
“The choice is clear, general practice needs a helping hand or else patients across Australia will be left behind.”
Mount Evelyn residents took to community noticeboards on social media to ask for advice on where to find an alternative bulk billing clinic but many have already made the switch or plan to from 1 September, including Mooroolbark Super Clinic and Lakeside Medical Centre in Lilydale.
“All doctors are doing out of pocket costs of $30 in the area. I looked around and they are all doing it,” one commenter posted.
“The Medicare rebate is not increasing in line with inflation. Doctors have been up in arms over it for some time and are now taking action,” another person wrote.
Dr Kumar said had wages not increased, there may have been a chance the clinics would have been able to survive on bulk billing but staff deserved to be paid appropriately.
He also said by continuing to just make ends meet, it’s the patient that suffers the most.
“The only way we can make the practice run is by getting the patients in and out. Otherwise, you can’t really run a practice and let’s not even talk about making a profit, it’s just more purely just to run a practice,” he said.
“So out of everyone, patients suffer if we don’t give enough time to them. If you’re not doing appropriate care, then that’s not good for anyone.”
Dr Kumar said the Lilydale and Mount Evelyn clinics had been preparing for patients to request a transfer to another doctor and while some have, it hasn’t been as severe as he initially thought.
“We only had a handful of patients’ requests come through to leave the practice. Most of the patients have been understanding.”
Healthcare and pensioner card holders will still be able to access bulk billing under the mixed billing model.
To help curb the $30 out of pocket fee the Lilydale and Mount Evelyn clinic will charge for a visit, Dr Kumar said should patients get tests of some kind, doctors will just message or call instead of requiring the patient to return to the clinic.
“We’re just trying to be mindful of everyone. All the costs are up, I’m in the same boat. So we’re being mindful so they don’t spend too much as well.”
Although not holding his breath, Dr Kumar said should Medicare rebates increase significantly or should inflation drop, he will consider returning to bulk billing but for now to ensure patients get the best level of care at a reasonable cost, the fee will be a long term feature.
“It wasn’t an easy decision. We had to sit down and we thought about it for quite a while before we actually did it.
“Finally the decision was either we lay off staff or shut down the clinic or increase the prices and at least try and offer some services.”
