Bulk Billing Booms with Strong Funding, Not Competition

The Royal Australian College of General Practitioners (RACGP) says new Cleanbill data indicates what GPs have consistently warned is true: bulk billing increases where funding better reflects the true cost of care, not where there is greater competition between practices.

The Cleanbill report, released today, breaks down bulk billing and gap fees by how rural a practice is based on Modified Monash Model (MM1–7) classification.

It shows that the largest increases in 100% bulk billing have occurred in regional and rural areas where government incentives are highest, yet where health department data show there are fewer GPs per person.

RACGP President Dr Michael Wright said the findings validate the College's call for an independent Medicare pricing body and a 40% increase in rebates for longer consultations.

"This report shows exactly what we said would happen has happened," Dr Wright said.

"When funding better matches the cost of care, bulk billing increases.

"This shows why our patients need the funding for their care to be set by an independent pricing authority which can ensure Medicare funding matches the cost of their care, particularly in areas where costs are higher or the GP workforce is more stretched.

"The current Federal Government's investments show the value it places on primary healthcare, but this doesn't guarantee the same level of commitment from future governments.

"An independent pricing authority would provide transparent, evidence‑based decision‑making that directs funding where it's most effective and most needed. This would give GPs the trust and certainty they need when they make financial decisions, including about billing policies.

"This isn't about competition between GP clinics. It's about whether Medicare funding comes anywhere close to covering the real cost of providing care."

Key findings from the Cleanbill report show:

• The share of practices bulk billing all patients rose more in MMM 2–7 regions than in metropolitan areas.
• Some of the largest increases, over 30%, occurred in more remote regions, where GP supply per person is lowest.
• Metropolitan areas, which have among the highest GP‑to‑population ratios, saw the smallest increases in full bulk billing.
• Average out‑of‑pocket costs rose by 13.5% for patients paying a gap, with higher costs persisting outside capital cities.

"This clearly demonstrates that intervening in the market doesn't deliver fair pricing or access, adequate funding does," Dr Wright said.

The RACGP warned the report also highlights a growing two‑tier system, with regional Australians more likely to face higher gaps when bulk billing is unavailable, despite having fewer local GP services.

"In most states, fewer than 35% of GP clinics are located outside capital cities," Dr Wright said.

"This workforce maldistribution, combined with inadequate Medicare rebates, makes access harder for patients who already face the greatest barriers."

The RACGP renewed its calls for:

• An independent Medicare pricing body to set rebates based on the real cost of providing care.
• A 40% increase to rebates for longer consultations, which remain significantly underfunded despite rising patient complexity.

"Incentives may shift behaviour in narrow ways, but they don't fix the system," Dr Wright said.

"If we want sustainable bulk billing and better access to care, Medicare must be properly priced, especially for longer, more complex consultations."

GPs (full-time equivalent) per 100,000 population by Modified Monash Model location, Cleanbill change in fully bulk billing practices