Out-of-pocket costs for GP attendances
This section presents information about how much patients paid out-of-pocket for a non-hospital attendance with a GP when the service was not bulk billed. While the initial analysis summarises the main changes in the average out-of-pocket costs (adjusted for inflation) since the introduction of Medicare in 1984, the focus of this section is on the last 20 years between 2003 and 2023.
This measure excludes GP attendances that occur in a hospital setting (this is consistent with reporting of Medicare statistics), which represented only 0.2% of all GP consultations during 2023. Out-of-pocket costs for Medicare subsidised GP attendances that occur outside of a hospital cannot be claimed through private health insurance and as such the patient must fund the out-of-pocket cost themselves.
GPs determine how they charge for the service they provide and may choose to:
- accept the patient’s Medicare rebate (with the patient’s agreement) as full payment for the service. This is known as bulk billing and the patient does not have to pay anything.
- bill the patient directly (where they do not bulk bill). This is known as patient billing and the patient has to pay for the service.
Many GPs do not exclusively either bulk bill their patients or patient bill, and instead have mixed-billing practices. Depending on the service or the circumstances of the patient, they may choose to bulk bill or patient bill.
Whenever a GP chooses not to bulk bill their patients and instead charges a fee greater than the scheduled Medicare rebate amount, the patient must pay the difference. This is typically known as out-of-pocket costs.
Private health insurance rebates
Some people choose to pay for private health insurance and as such may receive a rebate from their health fund to cover all or some of out-of-pocket costs for private services in hospital, depending on their level of hospital cover.
This report does not include information on rebates from private health insurers because private health rebates are not captured in Medicare claims data.
Patient out-of-pocket costs for a GP attendance in a non-hospital setting for Australia are discussed, as well as across states and territories, socioeconomic and remoteness areas. An analysis of the 10 LGAs with the highest average out-of-pocket costs and the 10 LGAs with the lowest average out-of-pocket costs over the last 5 years is also presented.
Note: All out-of-pocket costs referenced in this section are price adjusted to 2023 prices to account for inflation. The deflator for price adjustments is only available to 2023, hence out-of-pocket costs are reported to calendar year 2023.