FactCheck: do 86% of people visit the doctor for free?

The number of people who attend the doctor for free has gone from 82% under Labor to 86% under us.

– Health minister Greg Hunt, during the health policy federal election debate at the National Press Club, May 2, 2019.

During a debate with shadow health minister Catherine King, Hunt was defending the Coalition government’s track record on bulk-billing, claiming the number of people who visit their doctor without having to pay any out-of-pocket expense has risen since Labor’s time in power.

Verdict

The figures are accurate, but bulk-billing rates for GPs have been rising since a low point of 68.6% in 2004, meaning rates have risen during Labor’s time in office as well as since the Coalition won power in 2013.

Bulk-billing rates for specialist consultations are much lower than for GP visits, although they too have risen during the past decade.

Checking the source

In response to a request for a source on which the claim was based, a spokesperson for Hunt provided The Conversation with a spreadsheet of Department of Health data documenting annual Medicare statistics from 1984-85 to 2017-18.

It shows that 86.3% of “non-referred attendances (excluding practice nurse items)” at doctors’ surgeries were bulk-billed in 2017-18. In 2012-13, the last full financial year of the Labor government, the rate was 82.5%.

Free doctor visits

Patients who are bulk-billed when they visit the doctor do not pay a fee; the doctor accepts the Medicare rebate as full payment. In this sense, bulk-billed patients can be said to be visiting the doctor “for free”.

Bulk-billing rates are published annually by the Department of Health, and so are easy to compare over time. (The spreadsheet referenced by Hunt’s office can be downloaded via this page.)

The bulk-billing rate for GP consultations over the past 20 years has been steadily increasing, from a low of 68.6% in 2003-4 to the most recent figure of 86.3% in 2017-18. In the last full financial year of the Labor government, in 2012-13, the rate was 82.5%.

There is no specific entry for “GP visits” in the government figures. The closest approximation is the data for “total non-referred attendances (excluding practice nurse items) out of hospital”. The bulk-billing rates for these services are shown in the upper line of the graph below.

The lower line in the graph shows bulk-billing rates for specialists. Patients visit non-hospital specialists (such as dermatologists) when referred by a GP, but bulk-billing is less common for these consultations.

Bulk-billing rates for these services have increased over the past decade, but are still quite low at 41.3%. This means most patients who use these specialist consultations make an out-of-pocket payment for them.

Why is GP bulk-billing on the rise?

The long-run increase in bulk-billing rates for GPs (and to a lesser extent, for specialists) is a bit of a mystery. In the mid-2000s, when the rising trend began, it seems likely this was spurred by the introduction of bulk-billing incentives which offer extra payments to GPs who don’t charge an out-of-pocket fee to patients, and the increase in the Medicare benefit to 100% of the Medicare Benefits Schedule (MBS) fee for GP services – this was a one-off A$4.60 increase in the Medicare rebate for a standard patient visit.

However, when government funding for GP services began to be cut in real terms by the medicare rebate freeze in 2013, bulk-billing rates nevertheless continued to rise.

One possible explanation is that competition between GPs is keeping bulk-billing rates high. This theory is supported by the fact that the number of GPs in Australia is growing faster than the population.

Also worth noting is that while the proportion of GP consultations that are bulk-billed has continued to rise, the fees paid by the minority of patients who aren’t bulk-billed has continued to rise faster than inflation. - Peter Sivey

Blind review

This FactCheck is fair and accurate with respect to the data presented on the percentage of GP consultations that are bulk-billed. However, the minister’s quote referred to the percentage of people who are bulk-billed. This is a slightly different metric to the percentage of consultations.

This is because the people who are more likely to be bulk-billed (such as concession card holders) are also more frequent users of GP services. In fact, there is evidence that the reforms in the mid-2000s, referred to above, led to higher costs for patients who were not concession card holders. This is further evidenced by a 2018 report from the Australian Institute of Health and Welfare (AIHW, which compiles official government statistics on health benefits) showing that in the 2016-17 financial year, 34% of patients who made at least one Medicare-subsidised GP visit incurred an out-of-pocket cost. In other words, only 66% of people were consistently bulk-billed during that year.

As these data have not been routinely reported by the AIHW, we cannot judge whether the percentage of people bulk-billed rose or fell during the Coalition’s term in office. We can say that in 2016-17 this percentage was much lower than that claimed by the health minister. - Kees Van Gool

The Conversation’s FactCheck unit was the first fact-checking team in Australia and one of the first worldwide to be accredited by the International Fact-Checking Network, an alliance of fact-checkers hosted at the Poynter Institute in the US. Read more here.

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