‘Why aren’t you bulk-billing me?’: The headache conversation Mark Butler won’t let you escape

For practice manager Jess Tremain, it is always clear when a new promotional campaign for Medicare has begun.

“Despite not watching TV myself, I can tell because we will have another spike in patients asking about why we are charging them,” Ms Tremain says.

“And they are asking, rightfully so, because that is what they have been told based on the information available to them.”

Ms Tremain manages Village Practice, a clinic in Wollongong, NSW.

Founded in 2018, she said the clinic was established with mixed billing in mind, based on the belief that high-quality care needed more time, and therefore more funding, than Medicare offered.

“We did not set out to do five-minute medicine,” Ms Tremain said.

“So it hurts to have a patient turn around and say, ‘I saw this on the TV last night. It sounds like you are privately billing me when you do not need to do this.'”

In January, the Federal Government launched its new ad campaign with the slogan, “Medicare’s Got the Bill.”

The 30-second TV piece tells viewers that “more practices are offering bulk-billing” and that “seeing a GP is now more affordable and accessible for all Australians”.

It is part of a campaign that has also seen the government force clinics that are claiming the incentives for universal bulk-billing to display Medicare-branded posters on the front of their practice.

This material ranges from a metre-wide decal to an A3 poster on 170gsm satin paper declaring, “We Bulk-Bill Every Eligible Patient.”

“Last Thursday, a pensioner presented to our front desk, and when informed of the usual discount fee for her consult, she said she had seen on the news last night that GPs were now being paid three times more to bulk-bill, and she asked why we were not bulk-billing her,” Ms Tremain said.

“I explained that what had tripled was the bulk-billing incentive, not the Medicare rebate itself, and that even with the increased incentive, the total Medicare payment still does not cover the cost of providing the service.

“She was confused and frustrated: ‘Oh, that is not at all what I thought it meant.'”

But such conversations are not mistakes, some suggest.

Health economist Professor Stephen Duckett wrote last year that one goal of the government’s promotional campaign was to encourage patients to start questioning their GPs, to ask why they were not bulk-billing.

That pressure from patients onto clinics was one reason why he said he believed Labor would hit its goal of 90% bulk-billing of attendances by 2030.

“Consumer pressure may make life uncomfortable for GPs who continue to impose co-payments, especially in low-income areas,” Professor Duckett said.

However, Ms Tremain said, no matter how they looked at it, moving their clinic of nine GPs, three nurses and six admin staff to bulk-billing would leave them about $17,000 worse off a month.

“The recent increased funding towards urgent care clinics and bulk-billing clinics is wonderful. Prior to the changes, we were pretty much out of options for bulk-billing GPs in our area, and our hospital is inundated and struggling,” she said.

“But it feels particularly degrading that none of that funding is going towards increasing GP rebates, like we have been asking for years.

“Especially paired with yet more rounds of ‘if your GP is not bulk-billing you, they are being greedy’ marketing.”