Bulk billing dips with GP care more complex and costly

The findings came as no surprise to veteran GP Sabrina Saldanha, who last year had to remove bulk billing entirely at her Sydney practice of more than 30 years, unable to keep up with rising operating costs and the complexity of medical services.

Increases in government incentives have been unable to keep pace with the mounting costs of insurance, government regulations and payroll tax.

"One factor is the cost and the other really is the complexity of medicine; the amount of energy, time, effort, knowledge base, research that goes into every consultation has increased because of the changes in medicine over the years," Dr Saldanha told AAP.

"Patients are very time poor and that basically means they want to fit far more into their consultation."

Cost prevents more than one million Australians with a health complaint from seeing a doctor. (Alan Porritt/AAP PHOTOS)

The average out-of-pocket cost for patients increased four per cent year on year, Cleanbill's annual survey of nearly 7000 GP clinics found, with the price of a consultation averaging $43.38 in 2025.

Remarkably, the study found no Tasmanian clinics that would bulk bill a new adult patient without concessions. The island state also had the largest average out-of-pocket cost at $54.26.

The data made it easy to see why Australians with health complaints were increasingly opting out of seeing a doctor, Cleanbill founder James Gillespie said.

About 1.5 million people did not attend a GP with a health complaint due to cost, according to the Australian Bureau of Statistics' patient experiences survey released in November.

"The data is absolutely concerning, but it's not particularly surprising ... anyone who's gone to see a GP in recent years knows how few bulk-billing clinics remain and how high out-of-pocket costs can be," Mr Gillespie told AAP. 

Dr Saldanha noticed wealthier patients were more likely to maintain routine follow-ups with their GP than patients doing it tough, exacerbating health inequality.

Patients forced to switch to bulk-billing medical centres suffered from lower quality of care and missed out on the consistency of having their own GP.

The federal government defends its Medicare funding and disputes Cleanbill's bulk-billing figures. (Dan Peled/AAP PHOTOS)

Health Minister Mark Butler disputed Cleanbill's figures, which are considerably lower than the government's official bulk-billing rate of 77.2 per cent in November.

The government's figures show the ratio of all individual GP visits that were bulk billed, while Cleanbill's study showed clinics that would bulk bill a new adult patient without concessions.

"Official data shows our record investment to strengthen Medicare has stopped the freefall in bulk billing that was created under the Liberal and Nationals government," Mr Butler said.

The federal government tripled bulk-billing incentives in 2023 for pensioners, concession card holders and children, meaning GPs received a $21 bonus in cities and almost $40 in regional areas.

Given that lifted rates, Royal Australian College of General Practitioners president Michael Wright said an increase in Medicare funding should be front-of-mind heading to this year's federal election.

"Medicare has been underfunded for decades ... today's patient rebates don't come close to the cost of care, so people are paying more out of pocket, it's harder for GPs to bulk bill," he said.

"When people can't see their GP or delay care due to costs, their health gets worse and they are more likely to end up in hospitals ... that's bad for their health, and costs taxpayers more."

Opposition health spokesperson Anne Ruston blamed the government for failing to fix bulk billing, which posed a significant risk to Australians' health and hospital systems.

The Pharmacy Guild of Australia urges patients to consider pharmacies for some types of care, such as for everyday health conditions and vaccinations.