Bulk billing

Bulk billing is a payment option under the Medicare system of universal health insurance in Australia. It can cover a prescribed range of health services as listed in the Medicare Benefits Schedule, at the discretion of the health service provider. The health service provider, usually a doctor is paid 85% of the scheduled fee directly by the government by billing the patient via their Medicare card. The service provider receives only 85% of the scheduled fee but avoids the costs and risks of billing and debt collection. It could be described as a form of factoring.

The alternative to bulk billing is for the service provider to collect the fee directly from the patient (there is no restriction on this fee, which is determined by the provider). The patient may then claim the rebate online, over the telephone, by mail, at a Medicare office, or some service providers offer electronic lodgement at the practice using EFTPOS. That rebate is generally 75% of the scheduled fee (100% for general practitioner services).

Previously under Medicare, it was not permissible to charge the patient a co-payment with bulk billing (although this was previously permissible): a service provider who bulk bills for a service may not charge the patient further for that service.

2014 co-payment proposal

In the 2014 Australian federal budget, the Abbott Government proposed to impose a $7 co-payment for all bulk billed GP and medical test visits. The proposal was to reduce the medicare rebate payable to service providers by $5 (which applies to all consultations, and not just bulk billed ones) with the additional $2 paid by patients also going to providers. Initially, there was no option for bulk billers to opt out of the co-payment. $20 billion gathered from the $5 reduction in the rebate are to be designated to funding a new Medical Research Future Fund. The co-payment measure was initially recommended by the National Commission of Audit and adopted as a government measure in the 2014 federal budget, to commence from 1 July 2015.

The co-payment has been described as a rationing measure to decrease the number of unnecessary medical consultations, but was to apply on all consultations including those by critically ill patients, pensioners and others, and are cumulative with no threshold limits. The proposal has been widely criticised. Several GP clinics have indicated that they will weather this loss of revenue in order to continue providing free GP visits.

It was announced in December 2014, that the co-payment will be reduced to $5 in total and begin in 2015. Details of the changes have not been published.

Service providers may choose whether or not to use bulk billing. Most general practitioner services are bulk-billed, but less so in more affluent areas and in rural, regional and remote areas of Australia where there is a greater shortage of doctors and health care services. The key purpose of bulk billing is to provide an economic constraint on medical fees and charges.