Is Bulk Billing dying a death?

[Wanderer Returns]

It seems that fewer medical centres are offering 100% bulk billing for all patients these days. Most seem to offer what they describe as 'mixed billing', meaning bulk billing for the under-16s, pensioners and concession card holders only. Everyone else needs to pay, with fees and Medicare rebate amounts varying widely. Do you think this is the beginning of the end of free healthcare in Australia?

Edited December 11, 2020 by Wanderer Returns

[Guest The Pom Queen]

It still seems common where we are, although my GP moved clinics and it is up to the GP if he bulk bills or not. The notice on their website says they bulk bill concession/pensioners/under 16. Yet their other practice they bulk billed everyone. 
‘I also see a lot of Medical Centres where they have a fast turn around of Drs but they bulk bill everyone. These are no good for me as I need the same Dr who knows my medical history 

[starlight7]

It has never been free really round where we live. The only time we use the bulk billing services is for something very simple, otherwise we have to pay. It goes up in price every year . The prescriptions are subsidised but not free. When we first came we had to pay full cost so basically we only went to a GP if we were really ill which was fine then, we were young and pretty healthy. Now it is $76 for 5 minutes and you only get about half back from Medicare.

[Ausvisitor]

57 minutes ago, The Pom Queen said:

It still seems common where we are, although my GP moved clinics and it is up to the GP if he bulk bills or not. The notice on their website says they bulk bill concession/pensioners/under 16. Yet their other practice they bulk billed everyone. 
‘I also see a lot of Medical Centres where they have a fast turn around of Drs but they bulk bill everyone. These are no good for me as I need the same Dr who knows my medical history 

Now I get that some people really do benefit from seeing the same Dr who knows their medical history - but these are few and far between, and generally only those who are seeing their doctor more than once a month.

For everyone once, practice systems are modern enough now that any practitioner can familiarise themselves with your case in the 5 minutes before you walk through the door.

We all feel like we benefit from seeing the same doctor each time, this is generally true though - it's just a familiarity thing.

 

In actuality studies have shown a frequent turnover of doctors that you visit is actually beneficial to your health and diagnosis since familiarity breeds complacency, so always being "new" to the doctor means they diagnose and notice things someone who sees you 6 times a year misses - you also get frequent second opinions as someone else is always confirming previous diagnosis

[Wanderer Returns]

1 hour ago, starlight7 said:

It has never been free really round where we live. The only time we use the bulk billing services is for something very simple, otherwise we have to pay. It goes up in price every year . The prescriptions are subsidised but not free. When we first came we had to pay full cost so basically we only went to a GP if we were really ill which was fine then, we were young and pretty healthy. Now it is $76 for 5 minutes and you only get about half back from Medicare.

Blimey, that seems steep - what area are we talking about starlight?

[calNgary]

There is a clinic about 15 mins drive away thats abit like a walk in centre, open 7 days a week etc and they bulk bill all the time.

Personally i like seeing the same Dr and he only BB kids or if your there for a quick appointment, B12 jab, flu jab etc. Other things are charged ,its about $64 and you get some back from Medicare straight away (just over $30 i think it is now).. I guess the advantage of the Dr's here is you can normally get an appointment for the same day if you want it.

 Cal x

[Jon the Hat]

Most of it will be online in 10 years anyway, so should come back down in price / be centrally funded.  Probably use AI for the basic stuff and only talk to an actual doctor if you trigger concerning symptoms.  You can then trigger automated follow up to make sure you collected the prescription / took it / are feeling better all via app.  Its coming no doubt.

Edited December 11, 2020 by Jon the Hat

[Amber Snowball]

10 minutes ago, Jon the Hat said:

Most of it will be online in 10 years anyway, so should come back down in price / be centrally funded.  Probably use AI for the basic stuff and only talk to an actual doctor if you trigger concerning symptoms.  You can then trigger automated follow up to make sure you collected the prescription / took it / are feeling better all via app.  Its coming no doubt.

Don’t know what it’s like where you are @Jon the Hat but when I went to my GP yesterday the phlebotomist I see said the GPs seem to much prefer the current system under covid where they only see people that have been triaged as requiring it and are likely to continue as their new normal,( if they can get away with it!)

My concern is that so much can be identified with a face 2 face that would be missed otherwise as the person doesn’t verbalise an issue or simply doesn’t recognise there is another problem. Iykwim.

From my own work safeguarding issues being right up there.

[Ausvisitor]

3 hours ago, Amber Snowball said:

Don’t know what it’s like where you are @Jon the Hat but when I went to my GP yesterday the phlebotomist I see said the GPs seem to much prefer the current system under covid where they only see people that have been triaged as requiring it and are likely to continue as their new normal,( if they can get away with it!)

My concern is that so much can be identified with a face 2 face that would be missed otherwise as the person doesn’t verbalise an issue or simply doesn’t recognise there is another problem. Iykwim.

From my own work safeguarding issues being right up there.

Probably a hybrid is what we need. Doctors work on a triage system but if you haven't seen one in three years, the next time you call for an appointment it is face to face regardless of seriousness. This way they lower the day-to-day in person visits but eberyone gets a visual check very 3 years

[Guest The Pom Queen]

6 hours ago, Ausvisitor said:

Now I get that some people really do benefit from seeing the same Dr who knows their medical history - but these are few and far between, and generally only those who are seeing their doctor more than once a month.

For everyone once, practice systems are modern enough now that any practitioner can familiarise themselves with your case in the 5 minutes before you walk through the door.

We all feel like we benefit from seeing the same doctor each time, this is generally true though - it's just a familiarity thing.

 

In actuality studies have shown a frequent turnover of doctors that you visit is actually beneficial to your health and diagnosis since familiarity breeds complacency, so always being "new" to the doctor means they diagnose and notice things someone who sees you 6 times a year misses - you also get frequent second opinions as someone else is always confirming previous diagnosis

That is a very valid point. 
‘The problem I would have is that it would take probably 5 days and not 5 minutes for them to familiarise themselves with my complex medical history. I am also lucky because I have built up a good patient/dr relationship in that he is happy to insert a cannula in my arm every 2 days for me to self administer IV fluids and other drugs. If I had to see a new Dr each time I would have to explain everything to them.  It is bad enough when I present to emergency, I often need a bolus infusion immediately or I could die, but instead of getting on with it they go through the same questionnaire ie Why are you here today, Do you have any pain, What is your medical history, Let me take your BP and can you do a urine sample, Who do you live with, What support have you got at home....blah blah. The last time I went I had them asking 100 questions I was semi conscious and my husband lost it and told them to call my specialist, once they got off the phone they then treat it as an emergency and the next thing he is telling me I may die and had I got my power of attorney etc sorted and did I want reviving. 
‘So as you can see in my case having different Drs is not viable and could cost me my life. 
 

When I was healthy I thought and still do that the Aussie system is great in that you can go to any Dr’s clinic that you want anywhere across Australia. All you do is complete a new patient form and that’s it.  This is great for getting second opinions or changing Dr’s. 
I don’t know what happens with patients notes, I know there use to be a problem between interstate hospitals. I also know that my professor in the public system never knows what’s going on with my files from the private hospitals.

[Guest The Pom Queen]

How long are Drs appointments where you are and do you have to pay if you go over? I had to go to the Dr earlier this week and my carer was absolutely amazed that I was in there for 35 minutes, she even asked him if it was norm. He replied that I was a one off and that by the time he caught up with my hospital notes he didn’t actually spend that much time with me. 

[Amber Snowball]

17 minutes ago, Ausvisitor said:

Probably a hybrid is what we need. Doctors work on a triage system but if you haven't seen one in three years, the next time you call for an appointment it is face to face regardless of seriousness. This way they lower the day-to-day in person visits but eberyone gets a visual check very 3 years

You are probably right. I don’t think it’s ideal as that doctor/patient relationship/continuity of care underpins primary care. But in all honesty it’s long gone in a lot of places anyway. Not enough doctors/time/resources. On the other hand I am hopeful covid working might have reset the way people access healthcare in terms of using A&E like a GP for example.

[ali]

There's a mixture where I live, I travel to the next suburb (the surgery is bulk billing) and open 7 days a week and also offers late evening appointments.  The have arrangements with local radiology - i've had CT scans and not had to pay.

[MARYROSE02]

I wasn't aware of any change in bulk billing. Some doctors/medical centres do it and others not. The seven day clinic I use in Surfers Paradise is bulk billing, though i may have had to pay for the first visit. There are other seven day clinics, also bulk billing so I guess they compete with each other.

Referrals to specialists are another matter and the ones I saw recently both charged a fee, say $300 and I got some back on Medicare.

Other services, like blood tests and an MRI scan were both free on Medicare. 

I suppose if you have a doctor you like and they don't bulk bill it's a matter of choice.

[Parley]

There are plenty of bulk billing places around but you need to look for them.

[Quoll]

17 hours ago, Wanderer Returns said:

It seems that fewer medical centres are offering 100% bulk billing for all patients these days. Most seem to offer what they describe as 'mixed billing', meaning bulk billing for the under-16s, pensioners and concession card holders only. Everyone else needs to pay, with fees and Medicare rebate amounts varying widely. Do you think this is the beginning of the end of free healthcare in Australia?

It's never been universal free health care in Australia.  The system was not designed for that, it was always a co-pay system with bulk billing for those who could not afford the co-payment and if that is now being reinforced then, good job!  It always amazed me that migrating Poms seemed to think that you had to attend a bulk billing practice - it's not the NHS, never has been.

[Freemantle]

Moving to Freo most of the Drs in our area offer bulk bulling as a matter of norm without concession cards. A pleasant surprise.

[Wanderer Returns]

12 hours ago, Amber Snowball said:

My concern is that so much can be identified with a face 2 face that would be missed otherwise as the person doesn’t verbalise an issue or simply doesn’t recognise there is another problem. Iykwim.

From my own work safeguarding issues being right up there.

I totally agree. Accountability is tune to which every profession is dancing to these days where you're working with vulnerable people. Misdiagnoses are common-place, but if you made one via an online consultation and the outcome was serious, then everyone would ask why that patient wasn't seen in person. Also, there's the reassurance you get from a face-to-face consultation when you're told that lump or spot is nothing to worry about. Yes, there'll be more online consultations but if someone feels they really need to see a doctor in person (and they don't mind waiting), then they shouldn't be dissuaded from doing so.

[Wanderer Returns]

37 minutes ago, Quoll said:

It's never been universal free health care in Australia.  The system was not designed for that, it was always a co-pay system with bulk billing for those who could not afford the co-payment and if that is now being reinforced then, good job!  It always amazed me that migrating Poms seemed to think that you had to attend a bulk billing practice - it's not the NHS, never has been.

I've noticed on the occasions when I've been to places where the doctors don't BB, the surgeries are a lot nicer, less busy, and you never need to wait for an appointment, so I guess you still get what you pay for.

[Ken]

I don't know any near me that don't bulk bill. When we first moved here the one nearest us didn't bulk bill adults (although they did for children) but at some point they fell in line with all the others.

[starlight7]

Not many bulk bill round our part of Melbourne. We usually pay because we have been going to the same Doc for years and like her and she knows us very well but if she retires or leaves I would look elsewhere, perhaps at a bulk biller. 

[rtritudr]

On 11/12/2020 at 21:21, Wanderer Returns said:

Blimey, that seems steep - what area are we talking about starlight?

I don't know where she is.  But over here in Sydney my local clinic bills for $85 per short visit and it's not even an expensive area in terms of house prices/rent.

[Parley]

16 hours ago, rtritudr said:

I don't know where she is.  But over here in Sydney my local clinic bills for $85 per short visit and it's not even an expensive area in terms of house prices/rent.

But you get $37 back from Medicare.

[Paul1Perth]

Not where we live. A brand new centre has jst opened near us and it's all bulk billed. I changed doctors not long ago as the one we've been seeing for years moved to a new practice that charged per visit. He's getting old anyway and should retire.

There's a couple of choices within 5 mins drive of us and you get to register with one doctor, so he gets a feel for your history.

I took my son to the new place recently and the doctor was young and interested and gave him a pretty thorough checkover. 

Just depends where you live I guess.

I got my vasectomy done on bulk billing. Just rang round the docs that did the op in their surgery and found one that bulk billed near Joondalup. Moolanda Boulevard if any West Aussie is looking for the op

[MARYROSE02]

I imagined myself moving back to Sydney and not being sure where I was going to live but I wanted bulk billing GPs so:

Cherrybrook

Burwood

Ashfield

Mt Annan

Blacktown

North Ryde

North Sydney

Sydney  CBD

Surry Hills

Bondi Jn

Dee Why

Mona Vale

Frenchs Forest

Sutherland

Miranda

Bankstown

Parramatta

and Caddens which I've never heard of. - Penrith so add Penrith to my list https://en.wikipedia.org/wiki/Caddens,_New_South_Wales

So, I covered  various parts of the city, Northern Beaches, The Shire, Eastern Subs, Sydney, North Sydney, Inner Western subs, Western Subs, North Western Subs, South Western Subs.

I know there are plenty of bulk billing doctors here in Surfers - I use one myself which is also open seven days like many other clinics.

Just Google "bulk billing GPs in your area. I checked the prices too and they all say "bulk bill." One of two have bulk billing if you walk in and fee if you want to make an appointment. And without a Medicare card you have to pay of course.