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16th of July 2018

Australia News

Bulk-billing clinics 'turning away' complex patients

“So all of a sudden, you don’t have the comprehensive care that patients deserve. If it’s more complicated, you have to go elsewhere.”

Dr Seidel said longer consultations were better for patients, as they allowed doctors to talk through health issues, making them less likely to prescribe medication.

Yet most bulk-billing centres offer standard consultation times of just 10 or 15 minutes. Record numbers of Australians are now using their services, with the bulk billing rate at 85.8 per cent.

While there are Medicare rebates for consultations longer than 40 minutes, doctors say they make more money by charging for multiple short consultations, creating a “perverse” incentive to avoid difficult patients.

An ongoing review into the Medicare Benefits Schedule has been told that GPs who want to spend more time consulting are unfairly penalised.

“[It] allows some GPs to cream the system by seeing 10 patients an hour and earning $380, while good GPs see four patients an hour and can only bill $152 an hour,” one respondent said.

GPs can receive $37.60 for a consultation of less than 20 minutes, involving tasks such as taking a patient history and doing an examination.

But doctors such as Dr Chris Clohesy, a GP based in the Northern Territory, said Medicare rebates were not adequate for the growing load of complex cases.

“I recall a time when I was working in Adelaide when a young teenage girl had come in with her parents because she has been self-harming at home,” Dr Clohesy said.

“That took two-plus hours to organise, as all the other patients were waiting.”

He said he was unwilling to bill the family any out-of-pocket expenses, so he charged no more than $107, the bulk-billing rate for a consult over 40 minutes.

There is now concern some GPs are moving out of disadvantaged communities because the income generated through bulk-billing alone is not enough to keep their business going.

Dr Seidel said three GPs recently announced they were leaving the small town of St Helens on the Tasmanian coast.

“Why are they leaving?” he said.

“Let’s be realistic about it. It’s a rural community. There is a high rate of disability and unemployment. Everyone expects to be bulk billed.

“Doctors can’t go broke, so before they go broke, they leave – and that’s what happened.”

Australian Medical Association president Dr Tony Bartone, a Melbourne GP, said it was not a case of doctors crying poor. He said that if Medicare rates had kept up with the consumer price index, they would be more than double the current rate.

"Something has to give," he said. "It will be that either doctors reduce their rate of bulk billing or they will have to limit the consultation."

The Royal Australian College of General Practitioners is calling for all Medicare rebates for GP consults to be increased by 18.5 per cent. They are also calling for a new payment of $163 for consultations lasting an hour or more.

A spokesman for federal Health Minister Greg Hunt said the request had been referred to the Medicare Benefits Schedule taskforce to investigate.

A five-year Medicare freeze was lifted this week, delivering a 1.5 per cent increase on standard GP visits – or an increase of 55 cents for a consultation up to 20 minutes.

With Bart Lewis

Aisha Dow reports on health for The Age and is a former city reporter.

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