How GPs plan to end Medicare politics and change bulk billing for good

Australia’s GPs want the federal government to butt out of Medicare funding, saying decisions about rebates and prices should be delegated to an independent body to avoid the politicisation of healthcare.

The call from the Royal Australian College of General Practitioners would dampen future political fights over Medicare, ruling out such initiatives as the $8.5 billion boost to Medicare that became the centrepiece of Labor’s 2025 re-election campaign as well as previous government policies to freeze Medicare rebates.

Data from the office of Health Minister Mark Butler shows that the federal government’s Medicare investment is turning around GP bulk-billing rates: since November, when the Albanese government began paying doctors incentives not to charge patients out-of-pocket fees, 1300 extra clinics have become fully bulk billing.

For general adult patients targeted by the measure, bulk-billing rates have risen 7 percentage points in that time – the largest quarterly rise on record. They are up 6.4 points in NSW and 9.2 points in Victoria. The national bulk-billing rate for all patients sits at 81.4 per cent, up 4.3 points in the year since the promise was first made.

However, in its pre-budget submission, the college of GPs has said that an independent body should advise on Medicare rebates. These stipulate what the government pays doctors for certain services; doctors can then choose to charge patients a gap fee on top.

“Recent Medicare investments have shown the value the current federal government places on primary healthcare, but support from the current government doesn’t guarantee the same level of commitment from future governments,” said college national president Dr Michael Wright.

“Governments on both sides of politics have set rebates based on short-term political imperatives, rather than from a sound evidence base.”

The Albanese government is offering GP clinics additional lump-sum payments if they bulk bill all of their patients, in a bid for them to change their funding models.

But Wright said the key issue for GPs as they considered changing their business practices was the risk that the policy would not endure under future governments.

“For many practices, moving to become a fully bulk-billing practice is not just a financial decision – it is about trust,” he said.

“An independent authority enshrined in legislation would provide the certainty many GPs need when making financial decisions about the future of their practices. It would provide transparent, evidence‑based decision-making that directs funding where it’s most effective and most needed.”

Several of the college’s budget ideas in previous years – tripling bulk-billing incentives, and extending them to adult patients – have eventually become government policy as Labor has looked to restore the accessibility of primary care.

Health economist Stephen Duckett, a former secretary of the federal Health Department, said he had previously recommended the idea, as had recent reviews commissioned by the government.

“If you look at any GP comments, they say you can’t trust governments – by which they mean Liberal governments, but they don’t make that explicit – because they went ahead and froze the rebate,” Duckett said.

“My own view is that you can’t expect practices to change everything they do when it is at the whim of the government what the rebates are. If we want Medicare to be well accepted by the medical profession, as well as consumers, then fair fee-setting would have to be part of that.”

Both hospitals and aged-care facilities have independent pricing bodies. The college of GPs has highlighted recent data from the Report on Government Services that shows spending on hospitals rose 30 per cent over a decade, while spending on general practice had risen 13 per cent.

It also pointed out that the Medicare rebate for a standard consultation had risen 22 per cent since 2010, while health inflation had risen 62 per cent. A significant reason for the discrepancy was a freeze on Medicare rebates, introduced in the dying days of the Labor government in 2013 and maintained by the Coalition until 2018.

Wright said Medicare rebates had “failed to keep pace with inflation and rising operational costs, driving up out-of-pocket expenses and creating barriers to access”.

Duckett said the biggest barrier to introducing an independent pricing authority would be the Treasury, which would not want to lose any levers to control spending. Health spending is one of the most expensive budget items.

He suggested another way to bake in certainty would be legislating that Medicare rebates must rise with inflation – this would be more difficult, politically, for governments to change.

Butler, meanwhile, said his Medicare changes “are helping ease cost‑of‑living pressures, strengthen primary care, and ensure Australians can access reliable, high‑quality health services close to home”.

There are now 126 urgent care clinics across the country, with four more due to open this week. Australians have saved $2.2 billion on pharmaceuticals too, as the government has lowered the maximum co-payment for scripts to $25.

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