Bulk billing in decline: the GP you can't afford to see

Australia's Medicare system was built on a simple promise: that no Australian should be denied medical care because they can't afford it. That promise is being quietly broken.

Bulk billing - where a GP charges Medicare's scheduled fee directly and the patient pays nothing - was once the norm. Today, it's increasingly a privilege reserved for concession card holders, children, and those lucky enough to live near a clinic that still offers it. For millions of ordinary working Australians, a trip to the GP now comes with an out-of-pocket gap payment averaging $40 to $80 per visit, and sometimes much more.

What the numbers actually say

The statistics tell a damning story. According to the Australian Medical Association and Australian Institute of Health and Welfare data:

• Bulk billing rates for GP visits fell to around 77.6% in 2023-24, down from a peak of over 88% just a few years earlier
• In major cities, some areas have seen rates drop below 60%
• The average out-of-pocket cost for a non-bulk-billed standard GP visit now sits between $40 and $90 above the Medicare rebate
• A longer consultation (Item 23 or above) can leave patients $60–$120 out of pocket in a single visit
• Emergency department presentations have risen sharply, with preventable GP-level conditions now clogging hospital systems - costing the taxpayer far more than a subsidised GP visit ever would

For a family of four seeing a GP three or four times a year each, that's potentially $500–$1,500 in annual out-of-pocket medical costs - on top of taxes that already fund Medicare.

How did we get here?

The core problem is simple: Medicare rebates have not kept pace with the actual cost of running a medical practice.

The Medicare Benefits Schedule (MBS) rebate for a standard GP consultation (Item 23) is around $41.40. Running a GP practice - staff wages, rent, insurance, equipment, software - costs far more per patient. GPs who bulk bill are effectively subsidising the system out of their own income.

For years, federal governments from both Labor and the Coalition have failed to meaningfully index Medicare rebates to inflation or real practice costs. Between 2013 and 2019, the Coalition government imposed an outright freeze on Medicare rebates, letting inflation erode their value year after year. Labor, when in opposition, was loudly critical of this freeze. When Labor returned to power in 2022, they announced a triple bulk billing incentive for GPs seeing children under 16, concession card holders, and aged care residents - a welcome but targeted measure that left the majority of adult Australians without coverage.

The fundamental mismatch between rebates and practice costs was not fixed. GPs are small business operators, not public servants. When the economics don't work, they stop bulk billing - or they leave general practice entirely.

Who does this hurt most?

The people hardest hit are not the wealthy, who can absorb gap fees or access private health cover. They are:

• Low-income workers who earn too much for a concession card but too little to easily absorb $60+ gap fees
• People with chronic conditions who see a GP frequently
• Rural and regional Australians, where GP shortages mean patients often have no alternative clinic to shop around
• Young people and renters, already under cost-of-living pressure, who increasingly delay or avoid medical care
• Mental health patients, where longer consultations carry higher gap fees

Delaying care doesn't make illness go away. It makes it worse - and more expensive to treat.

Why does this policy persist?

This is where it gets uncomfortable. The bulk billing crisis isn't an accident or an oversight. It's the result of deliberate choices made over many years by governments of both major parties.

Why? Several reasons:

• Short-term budget optics: Indexing Medicare rebates properly would cost the Commonwealth budget money upfront, even if it saves money long-term through avoided hospitalisations
• Political calculation: Cuts and freezes are easier to implement gradually and quietly than in a single dramatic move
• Lobbying and institutional inertia: Private health insurers benefit when the public system weakens, and they are well-resourced advocates in Canberra
• Accountability gaps: Voters don't get to vote on Medicare rebate schedules. Governments set these behind closed doors, adjust them in budget documents, and rarely face a direct political consequence for the slow erosion of a popular system

The result is a policy that no ordinary Australian would vote for if asked directly - but one that has survived for over a decade under governments of both stripes.

What would Australians actually choose?

Polling consistently shows that Australians strongly support Medicare and would prioritise restoring bulk billing access. A 2023 Resolve Political Monitor survey found healthcare was among voters' top three concerns, and support for increased Medicare investment was strong across the political spectrum.

But wanting something and being able to vote for it are two different things. Under our current system, you vote for a party every three years, and that party then makes hundreds of decisions - including on Medicare rebates - without any further democratic input from you.

Direct democracy changes that equation. If Australians could vote directly on whether Medicare rebates should be indexed to real practice costs, the outcome would likely be very different from the status quo. If members of parliament were required to vote the way their constituents actually instructed them to, the decade-long rebate freeze would never have survived.

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At Direct Democracy, we believe that decisions like this - decisions that affect every Australian's access to basic healthcare - should not be made by career politicians balancing budget optics and lobbyist relationships. They should be made by you.

Want a say in Australia's health policy - and every other policy that affects your life? [Join Direct Democracy today](https://directdemocracy.com.au/join) and become part of a movement that puts the vote back where it belongs: in your hands.