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*Pic: Image from here

Medicare bulk-billing rates for GP visits in Tasmania have dropped to their lowest level for five years, apparently in response to the federal government’s continuing freeze on Medicare rebates.

The rebate for a standard consultation has not risen since July 2014. When this year’s federal budget showed the freeze would remain in place for at least another four years, many GPs – including most of Tasmania’s ‒ abandoned or severely cut back their bulk billing of patients.

In Hobart, it is now almost impossible for a new patient to gain a bulk-billed consultation from a GP. ‘Gap’ payments demanded from patients for a 10 or 20-minute visit are typically in excess of $30.

For practices adhering to the Australian Medical Association’s recommended fee list, gap payments are increasing by 6.5 per cent a year.

In Tasmania, the average gap fee charged to patients is $34.87, slightly higher than the national average.

Figures released by the Commonwealth Department of Health show that in the September quarter, GP bulk-billing rates in Tasmania fell to 74 per cent, from 76.4 per cent three months earlier. It was the largest fall in the nation and compares with a national average of 84.1 per cent.

Nationally, the rate dropped less severely ‒ from 84.6 to 84.1 per cent between the two quarters. But it appears to signal a reversal of bulk-billing rates generally as doctors adapt their billing procedures in the light of the government’s ongoing Medicare freeze.

The AMA’s vice-president, Dr Tony Bartone, said the downturn was expected.

‘The MBS freeze has finally bitten to a point where doctors and practices have to make a decision to actually reduce the rate of bulk-billing available, and actually institute higher fees to cover the rising costs which they’ve really absorbed over many years now,’ he told Sky News.

‘Doctors provide an essential service, and patients need to continue consulting their doctors, for whatever reason that might be, and that will continue. But the ability to provide a bulk-billing solution is now really questionable going into the future with this ongoing freeze, and of course patients will have to make a decision to … balance their own budget.’

Earlier the president of the Royal Australian College of General Practitioners, Dr Bastien Siedel ‒ a Huon GP ‒ said the next quarterly figures were likely to show a more complete picture of what is happening.

‘General practice has been unfairly targeted by the Medicare patient rebate freeze,’ he said last month. ‘As a consequence we have seen patient out of pocket fees and co-payments increasing since the last Federal Budget. We now know that there never was a financial rationale to subject general practice to the Medicare freeze in the first place. Consequently the freeze needs to be lifted now.’

‘Australians are already seeing the impact of this six-year Medicare freeze every time they go to the doctor with more and more patients having to pay out of their own pocket,’ Dr Siedel said.

The shadow health minister, Catherine King, said the figures were clear evidence that the rebate freeze was biting.

‘On the day before the election Malcolm Turnbull promised that no Australian would pay more to visit the doctor. This was a complete and utter lie, she said.

‘The Government needs to pull their head out of the sand and admit that their health policies are hurting Australians.’

Health Minister Sussan Ley denied that bulk billing rates were falling.

‘No matter how Labor tries to spin it, today’s figures again show that Medicare investment and bulk billing rates continue to remain higher under the Coalition than under Labor,’ she said.

*Martyn Goddard is a Hobart-based policy analyst specialising in health issues. He is a former journalist and ABC documentary maker who became involved in health policy during the AIDS crisis in Sydney. Since then he has been a member of the main Commonwealth advisory bodies on AIDS and hepatitis and was the first consumer member of the committee that lists drugs on the PBS. He was also health policy officer for the Australian Consumers’ Association. For the past decade he has concentrated on examining and explaining Tasmania’s health issues.