Patterns in GP bulk billing rates between 1984 and October 2024
Over the last 40 years, the national GP bulk billing rate has increased over time. At the start of Medicare in 1984, the annual GP bulk billing rate was 51% before increasing to a 40-year high of 89% in 2020. Since then, it decreased to 77% in 2023 before increasing slightly to 78% in the first 10 months of 2024.
There have been 2 main periods in the 40-year history of Medicare where the GP bulk billing rate has increased (Figure 1):
- In the 12 years between 1984 and 1996, where the annual GP bulk billing rate steadily increased to 81% in 1996 (an annual average increase of 2.5 percentage points for each year since 1984).
- In the 17 years between 2003 and 2020, when the annual GP bulk billing rate increased to 89% in 2020 (an annual average increase of 1.2 percentage points for each year since 2003).
During 2020, the monthly GP bulk billing rate peaked in April when it reached 94% (which was also the highest national GP bulk billing rate to date).
Following each period of growth, the annual GP bulk billing rate declined. In the 7 years from 1996 to 2003, it fell to 68% (an annual average decrease of 1.8 percentage points for each year between 1996–2003). After 2020, the annual GP bulk billing rate decreased to 77% in 2023 (an annual average decrease of 4.0 percentage points for each year between 2020–2023).
The reasons for the changes in the annual GP bulk billing rate are complex and can include:
GPs are free to choose whether they bulk bill a patient or bill a patient directly. The Australian Medical Association recommends that all GPs should determine their own fees based on the cost of running a medical practice and the individual circumstances of the patient. The cost of running medical practices varies across the country and includes things such as wages, rent, electricity, and insurance. If the costs to run a medical practice increase, GPs may need to charge a fee greater than the scheduled Medicare fee, resulting in a move away from bulk billing to billing the patient directly.
Over time, the number and composition of GP attendance items listed on the MBS schedule has changed as other items have periodically been introduced to reflect the work of GPs. For example, as at 1 February 1984 there were 45 GP MBS items available. This has now risen to approximately 360 GP MBS items as at 31 October 2024, noting that items are added to and removed from the MBS schedule periodically.
While GP attendance items generally focus on GP consultations over varying time intervals, content-based GP items were introduced in December 1989. From 1999 enhanced primary care items were introduced to the schedule to provide additional support to patients with chronic health conditions and complex care needs. More recently, additional longer GP attendance consultation items were also added to the MBS on 1 November 2023. These are just some of the changes to the MBS schedule and for information on changes, see MBS Online.
The Medicare Benefits Schedule (MBS) is a list of the medical services for which the Government provides a Medicare rebate (that is, Medicare benefit), to provide patients with financial assistance towards the costs of the medical services.
History of Medicare
Since Medicare was implemented, the Australian Government has introduced various policies aimed at either increasing the bulk billing rate, improving the affordability of GP services for patients, or improving the overall affordability of Medicare for the Government.
The following is a high-level overview of some of the key policy changes. Note that this is not a complete list of changes or a review of the effectiveness of the policies.
As part of the 1991–92 Budget, the Medicare rebate for non-hospital GP attendances was reduced for non-concessional patients. In addition, a co-payment was introduced for non-concessional patients when being bulk billed. This initiative was implemented on 1 December 1991 (Commonwealth Department of Health, Housing and Community Services 1991) and discontinued from 1 March 1992. Although this initiative was temporary, the average out-of-pocket costs increased from $17 in November 1991 to $23 in December 1991 before returning to $16 in March 1992 (inflation adjusted).
For more information, see Budget Statements 1991–92.
The Strengthening Medicare (Department of Parliamentary Services 2004) initiative introduced on 1 February 2004 included:
- a series of new bulk billing incentive items for GPs, to provide an incentive for GPs to bulk bill concession card holders and children under the age of 16 years, particularly in regional, rural and remote areas.
- the introduction of a new Extended Medicare Safety Net, which provided reimbursement of 80% of all out-of-pocket costs for medical services provided outside hospitals (that is, doctors’ visits and medical tests such as pathology examinations) once certain thresholds were reached.
After the introduction of this initiative, the annual GP bulk billing rate increased to 71% by the end of 2004.
The 100% Medicare initiative, which began on 1 January 2005, increased the Medicare rebate for non-hospital GP attendances to 100% of the schedule fee. Previously, the Medicare rebate had only been 85% of the schedule fee for out-of-hospital services. This meant patients who were non-bulk billed after 1 January 2005 had a lower out-of-pocket cost due to the increase in the Medicare rebate, assuming the fee charged by GPs remained the same.
Since 1986, various parts of the MBS were indexed. After July 2014, a freeze on indexation was introduced – known as the Medicare rebate freeze (Parliamentary Library 2017) – and later removed from July 2017 in a phased lifting. However, the re-introduction of indexation did not extend to all MBS items. Analysis conducted by the Australian Parliament (Parliamentary Library 2017) identified the impact of the indexation freeze was not clear as the GP bulk billing rate initially remained steady, however the patients who were billed directly faced higher out-of-pocket costs.
The Australian Government’s COVID-19 response included doubling the schedule fees for bulk billing incentive items between March and September 2020 and the introduction of several temporary telehealth items that were required to be bulk billed (Department of Health and Aged Care 2020a, 2020b). Following the introduction of these changes, the annual bulk billing rate for GP attendances subsequently increased to 89% in 2020.
For more information, see the Government’s COVID-19 response.
The Building a stronger Medicare policy which commenced on 1 November 2023, included (alongside other initiatives) an additional investment measure that tripled the amount of bulk billing incentive payments for the most commonly claimed GP attendances. These incentives were designed to support free GP consultations for patients under 16, pensioners and other Commonwealth concession card holders. This policy also included an increase in the indexation of the Medicare rebate.
Since November 2023, the monthly GP bulk billing rate increased to 77% in October 2024.
Patterns in GP bulk billing rates by age group
The monthly and annual GP bulk billing rates in the age groups of 0–15, 16–64 and 65+ years (Figure 1) all followed the overall national trend between 1984 to the end of October 2024.
Between 1984 and 2013, the 65+ age group had the highest annual GP bulk billing rate (an average of 85% over this entire period) out of the 3 age groups. The 0–15 age group had an average bulk billing rate of 74% and the 16–64 age group had the lowest average rate of 71% over this entire period.
Since 2014, the 0–15 age group had consistently higher annual GP bulk billing rates (an average of 92% between 2014 and 2023) compared with the other 2 age groups. The 16–64 age group had an average GP bulk billing rate of 81% and the 65+ age group had an average rate of 90% between 2014 and 2023.
In 2020, the annual GP bulk billing rate peaked for all age groups, when it reached 94% for the 0–15 age group, 87% for the 16–64 age group and 93% for the 65+ age group. From 2021 to 2023, the bulk billing rate for all 3 age groups then declined.
During the first 10 months of 2024, for the:
- 0–15 age group, the average GP bulk billing rate increased from 88% in 2023 to an average of 90%.
- 16–64 age group, the average GP bulk billing rate decreased from 70% in 2023 to an average of 69%.
- 65+ age group, the average GP bulk billing rate increased from 86% in 2023 to an average of 87%.
The 16–64 age group formed the greatest proportion of all GP attendances (54%) and almost half of all bulk billed GP attendances (48%) during the first 10 months of 2024 (Table 1). As a result, the relatively lower bulk billing rate for this age group is lowering the national average bulk billing rate.
At the time of publishing this report, data for the full year of 2024 was unavailable. It is too soon to tell what the overall trend for 2024 will be for all age groups.
Age group | Bulk billing rate | Bulk billed GP attendances (million) (% of total) | GP attendances (million) (% of total) |
|---|---|---|---|
0–15 | 90% | 15.1 (14%) | 16.8 (12%) |
16–64 | 69% | 52.3 (48%) | 75.8 (54%) |
65+ | 87% | 42.1 (38%) | 48.2 (34%) |
Total | 78% | 109.5 (100%) | 140.8 (100%) |
Source: AIHW analysis of MBS data maintained by the Australian Government Department of Health and Aged Care.
Figure 1: GP bulk billing rates by age group, 1984 to October 2024
The annual GP bulk billing rate shows an increase from 51% in 1984 to 81% in 1996. This is followed by a decrease to 68% in 2003. The rate then increased to a high of 89% in 2020, before decreasing to 77% in 2023. The rate in the first 10 months of 2024 was 78%. The annual GP bulk billing rate of the 0–15 age group was 90% in the first 10 months of 2024, 69% in the 16–64 age group and 87% in the 65+ age group.
