Medicare bulk billing and out-of-pocket costs of GP attendances over time

Medicare is Australia’s publicly funded universal healthcare system that pays for some or all of the costs associated with medical services, including general practitioner (GP) consultations (where a patient and GP discuss the patient's health).

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.
• charge a fee greater than the Medicare rebate. In this instance, the patient needs to pay a contribution towards the cost, which is known as out-of-pocket costs.

This report focuses on 2 key measures (calculated monthly and annually):

• the bulk billing rate (%) for GP attendances (referred to as the GP bulk billing rate). This is the number of bulk billed GP attendances divided by the total number of all GP attendances x 100.
• the average amount of out-of-pocket costs people paid for GP attendances (non-hospital) when they were not bulk billed. This is calculated by dividing the out-of-pocket costs for (non-hospital) GP attendances by the number of (non-hospital) GP attendances delivered to patients.

The bulk billing rate for GP attendances has decreased after the start of the COVID-19 pandemic

The annual and monthly GP bulk billing rates have changed over recent years. Before the COVID-19 pandemic, the annual GP bulk billing rate sat at 86% in 2019. During the pandemic, the annual GP bulk billing rate rose to a peak of 89% in 2020, partly driven by a short period of mandatory bulk billing of GP attendances delivered through video conferences and telephone consultations. This bulk billing rate remained high due to the mandatory bulk billing of over 19 million assessments of patient suitability for a COVID-19 vaccine (which comprised 10% of GP attendances) in 2021.

After the initial impact of the COVID-19 pandemic and the roll-out of COVID-19 vaccines, the GP bulk billing rate declined steadily – reaching a monthly low of 75% in October 2023. On 1 November 2023, bulk billing incentive payments commenced at triple the previous rebate as an incentive for GPs to bulk bill children under the age of 16 and concession card holders. Following the commencement of the higher incentive payments, the monthly GP bulk billing rate increased to 77% in October 2024.

Bulk billing for GP attendances varied depending on where patients lived, with NSW having the highest rates and ACT the lowest rates

The GP bulk billing rate was different between states and territories. In 2023, New South Wales had the highest annual GP bulk billing rate of 82%. In contrast, the Australian Capital Territory had the lowest with an annual rate of 53% in 2023.

From November 2022–October 2023, all states and territories had a decrease in GP bulk billing rates compared with November 2021–October 2022. After the increase in bulk billing incentive payments was introduced in November 2023, the GP bulk billing rate has started to increase in some states and territories. The largest increases in GP bulk billing rates in November 2023–October 2024 (compared with November 2022–October 2023) were seen in:

• Tasmania (GP bulk billing rates increased from 68% to 72%), and
• Northern Territory (GP bulk billing rates increased from 72% to 75%).

People in lower socioeconomic areas are more likely to be bulk billed for GP attendances and pay less when not bulk billed

People living in lower socioeconomic areas generally have a higher GP bulk billing rate. In 2023, the annual GP bulk billing rate for the lowest socioeconomic areas was 87% compared with 68% in the highest socioeconomic areas.

People in lower socioeconomic areas typically pay less to see a GP. In 2023, for those who incurred an out-of-pocket cost, people living in the lowest socioeconomic areas paid an average of $39 for non-bulk billed (non-hospital) GP attendances, compared with an average of $47 in the highest socioeconomic areas.

People in more remote areas are more likely to be bulk billed for GP attendances but pay more when not bulk billed

People living in more remote areas tend to have a higher GP bulk billing rate. In 2023, the annual GP bulk billing rate was 89% in Very remote areas compared with 78% in Major cities.

People in more remote areas usually pay more for a GP visit. In 2023, for those non-bulk billed (non-hospital) GP attendances, patients paid an average of $49 in out-of-pocket costs in Very remote areas, compared with an average of $43 in Major cities.