Is Bulk Billing dying a death?

[MARYROSE02]

3 minutes ago, Paul1Perth said:

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

When I was in South Perth I found a GP which I liked in Mends St and they do charge, but as I liked that practice and would go back to it if I return to Perth I don't mind paying. I am sure I could find a bulk billing one if I wanted it. I could walk to the Mends St practice too, i.e. why drive to a bulk billing place if there is one I can walk to, like, but it does not bulk bill.

Here in Surfers my bulk billing GP is five minutes walk away. I went down there in the rain with some "samples" (OK, I'm sure you want to know what kind of samples - three different "movements"**) and I forgot the form so had to go back and forth to get the form.  Five minutes walk each way, no problems.

** I have been having colonoscopies in Sydney every three years but this time in Surfers Paradise, it seems that every three years may be too often, There is no bowel cancer in my family although one of my brothers has had polyps. The GP referred me to a specialist and when I went back to the GP he did some blood tests and the three poo tests. I've done the ones the Government pushes us all to do, slightly different to this one I've just done. I guess if any sign of blood shows up I may have to go through with the colonoscopy.

[Paul1Perth]

On 12/12/2020 at 08:41, 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.

But why wouldn't you if one is available?

[Quoll]

5 hours ago, Paul1Perth said:

But why wouldn't you if one is available?

Continuity of care 

[Freemantle]

On 17/12/2020 at 03:54, Quoll said:

Continuity of care 

We were bulk billed over east as a matter of course despite us both working, with  continuity of care and we anticipate the same here in WA.

 

[MARYROSE02]

37 minutes ago, Freemantle said:

We were bulk billed over east as a matter of course despite us both working, with  continuity of care and we anticipate the same here in WA.

 

Bulk billing, unlike the state pension, is not means tested, so anybody can use it so long as they have a Medicare card

[Quoll]

48 minutes ago, MARYROSE02 said:

Bulk billing, unlike the state pension, is not means tested, so anybody can use it so long as they have a Medicare card

It isnt means tested but it should be.  Bulk billing was designed for people who could not afford to pay the co-payment.  

[Freemantle]

4 hours ago, MARYROSE02 said:

Bulk billing, unlike the state pension, is not means tested, so anybody can use it so long as they have a Medicare card

Some doctors may have a policy where they bulk bill certain patients, such as Age Pension recipients or Seniors Card holders, while others may include Health Care Card holders, students and children aged under 16 years. Some may also choose to bulk bill patients for follow-up appointments where they receive test results.

Certain medical centres may offer to bulk bill all patients, regardless of their age or income, and some services that operate after regular business hours and offer home visits also bulk bill.

People who may be eligible for bulk billing

• Age Pension pensioners
• Seniors Card holders
• Health Care Card holders
• Students and children
• Children under 16 years of age
• After hours/home visit services
• All patients at a designated bulk billing practice

https://www.canstar.com.au/health-insurance/bulk-billing/

 

[Wanderer Returns]

9 hours ago, MARYROSE02 said:

Bulk billing, unlike the state pension, is not means tested, so anybody can use it so long as they have a Medicare card

 

8 hours ago, Quoll said:

It isnt means tested but it should be.  Bulk billing was designed for people who could not afford to pay the co-payment.  

That's what's odd about the system - there's no consistency. Let's be honest, many people would drive a another 10 or 15 minutes to see a doctor, or wait a few days longer if it was going to save them $50 or more. Personally, I would just rather pay a bit more tax and everywhere be bulk-billed, like it is in the UK.

[Wanderer Returns]

4 hours ago, Freemantle said:

Some doctors may have a policy where they bulk bill certain patients, such as Age Pension recipients or Seniors Card holders, while others may include Health Care Card holders, students and children aged under 16 years. Some may also choose to bulk bill patients for follow-up appointments where they receive test results.

Certain medical centres may offer to bulk bill all patients, regardless of their age or income, and some services that operate after regular business hours and offer home visits also bulk bill.

People who may be eligible for bulk billing

• Age Pension pensioners
• Seniors Card holders
• Health Care Card holders
• Students and children
• Children under 16 years of age
• After hours/home visit services
• All patients at a designated bulk billing practice

https://www.canstar.com.au/health-insurance/bulk-billing/

 

What you have described is commonly referred to as 'mixed billing'.

[Quoll]

10 hours ago, Wanderer Returns said:

 

That's what's odd about the system - there's no consistency. Let's be honest, many people would drive a another 10 or 15 minutes to see a doctor, or wait a few days longer if it was going to save them $50 or more. Personally, I would just rather pay a bit more tax and everywhere be bulk-billed, like it is in the UK.

You may prefer it that way, but this is Australia and it wasn't designed to be that way. 

It wasn't until the big largely foreign owned medical centres arrived that the "bulk bill everyone" practice started and, from talking to folk who've been around a long while they're in the "churn them through and get them to come back repeatedly" market, so it's rather quantity than quality which counts for them. I'm sure someone  has had a fabulous doctor at a big medical centre who has seen them and their kids through lifelong illnesses but that may be luck of the draw..  When they first started up around here, we were encouraged to go for after hours appointments on a locum  arrangement. I must've been unlucky with the ones I encountered! 

[Freemantle]

There appears to be no hard and fast rules. In the mining sector WA north, I found next to none bulk billing, it cost a small fortune for a family to attend a surgery, not all residents work in mining, and this placed insurmountable pressure on the local hospitals.

Private health care and gap fees can also be another bone of contention. My OH had a surgical procedure on his hand, gap fee $4,000 which we duly paid, his other hand 6 months later required the same op, I went Dr shopping, no gap,  only  the consultation  which was $250!

[Quoll]

1 minute ago, Freemantle said:

There appears to be no hard and fast rules. In the mining sector WA north, I found next to none bulk billing, it cost a small fortune for a family to attend a surgery, not all residents work in mining, and this placed insurmountable pressure on the local hospitals.

Private health care and gap fees can also be another bone of contention. My OH had a surgical procedure on his hand, gap fee $4,000 which we duly paid, his other hand 6 months later required the same op, I went Dr shopping, no gap,  only  the consultation  which was $250!

The big medical centres tended to set up in high population areas so they could get the numbers churning through so country towns dont make it viable for them and country folk have to do the co-pay, if, indeed they can find a doctor at all!  Canberra isnt that well endowed with bulk billing options - it used to be nigh on impossible to get a high needs person - like a drink/drug addict seen by a bulk biller and that was a bone of some contention amongst support services..

[Freemantle]

1 minute ago, Quoll said:

The big medical centres tended to set up in high population areas so they could get the numbers churning through so country towns dont make it viable for them and country folk have to do the co-pay, if, indeed they can find a doctor at all!  Canberra isnt that well endowed with bulk billing options - it used to be nigh on impossible to get a high needs person - like a drink/drug addict seen by a bulk biller and that was a bone of some contention amongst support services..

Its amazing how different states differ. We are most impressed with what is on offer here in WA, and preventative medicine seems high on the list at many of the surgeries which is refreshing to see!

[Wanderer Returns]

1 hour ago, Freemantle said:

There appears to be no hard and fast rules. In the mining sector WA north, I found next to none bulk billing, it cost a small fortune for a family to attend a surgery, not all residents work in mining, and this placed insurmountable pressure on the local hospitals.

Private health care and gap fees can also be another bone of contention. My OH had a surgical procedure on his hand, gap fee $4,000 which we duly paid, his other hand 6 months later required the same op, I went Dr shopping, no gap,  only  the consultation  which was $250!

Gap fee? Exactly how does this work?

[Freemantle]

4 minutes ago, Wanderer Returns said:

Gap fee? Exactly how does this work?

A gap payment is an out-of-pocket expense you have to pay when you receive medical treatment that costs more than what you can claim back from Medicare or your private health insurance. Regardless of whether you're a public or private patient, Medicare will subsidise some of the cost. (Apologies for the copy and paste). In my experience  some of the gap fees have been exhorbitant, hence  we have "specialist shopped" within our health fund and been very pleased at some of the "no gap" fees available!

 

Edited December 19, 2020 by Freemantle
Spelling mistake

[Wanderer Returns]

3 minutes ago, Freemantle said:

A gap payment is an out-of-pocket expense you have to pay when you receive medical treatment that costs more than what you can claim back from Medicare or your private health insurance. Regardless of whether you're a public or private patient, Medicare will subsidise some of the cost. (Apologies for the copy and paste). In my experience  some of the gap fees have been exhorbitant, hence  we have "specialist shopped" within our health fund and been very pleased at some of the "no gap" fees available!

That's good to know for when I need to get something done (hopefully not for a while yet!) - thanks for the explanation.

[Freemantle]

3 minutes ago, Wanderer Returns said:

That's good to know for when I need to get something done (hopefully not for a while yet!) - thanks for the explanation.

This link probably explains the gap benefits Wanderer. https://www.medibank.com.au/livebetter/my-medibank/using-your-cover/how-does-gapcover-work/....so if you are with Medibank Private for example, I go into "Member's Choice https://www.medibank.com.au/health-insurance/find-provider/#/ and this should show me participating specialists. My OH's GP always referred patients to the same surgeon locally but finding your own participant surgeon can save you some mega bucks!

[Marisawright]

17 hours ago, Wanderer Returns said:

That's what's odd about the system - there's no consistency. Let's be honest, many people would drive a another 10 or 15 minutes to see a doctor, or wait a few days longer if it was going to save them $50 or more. Personally, I would just rather pay a bit more tax and everywhere be bulk-billed, like it is in the UK.

It's not odd, it's business.  Dr Dougster shot me down for this before, but the point is that GP's run their own businesses.  Some will choose to run a more personalised, boutique service  where others will go for a low-cost, quick-service option.  What they charge will vary accordingly.   

As Quoll said, the original idea of Medicare was not to dictate to GPs what they should charge (because they are independent businesses, so that wouldn't be appropriate).  The doctor set their own fees, the patient paid it, and claimed some of it back from Medicare.

Then along came the big companies, who built big medical centres.   They had economies of scale - employing a large number of doctors in one place with shared support staff.  Bulk-billing meant drastically simplified accounting and administratoin which saved more costs.  Then all they had to do was churn patients through on short appointments. The focus was very much on profits, and anyone who could afford a "proper" doctor avoided them!  Eventually there was a shakeout in the industry and I don't think that kind of shonky practice goes on now.  I go to a bulk-billing practice and have no complaints. 

 

Edited December 19, 2020 by Marisawright

[MARYROSE02]

On 18/12/2020 at 10:53, Quoll said:

It isnt means tested but it should be.  Bulk billing was designed for people who could not afford to pay the co-payment.  

I never thought about that to be honest. I just assumed it was like in the UK where, unless it has changed since I was there, there is no means testing when you go to see a GP?

Most  of the time I don't care. If it is bulk billed then great. If I have to pay either in part or in full, then that is OK too.

[MARYROSE02]

35 minutes ago, Marisawright said:

It's not odd, it's business.  Dr Dougster shot me down for this before, but the point is that GP's run their own businesses.  Some will choose to run a more personalised, boutique service  where others will go for a low-cost, quick-service option.  What they charge will vary accordingly.   

As Quoll said, the original idea of Medicare was not to dictate to GPs what they should charge (because they are independent businesses, so that wouldn't be appropriate).  The doctor set their own fees, the patient paid it, and claimed some of it back from Medicare.

Then along came the big companies, who built big medical centres.   They had economies of scale - employing a large number of doctors in one place with shared support staff.  Bulk-billing meant drastically simplified accounting and administratoin which saved more costs.  Then all they had to do was churn patients through on short appointments. The focus was very much on profits, and anyone who could afford a "proper" doctor avoided them!  Eventually there was a shakeout in the industry and I don't think that kind of shonky practice goes on now.  I go to a bulk-billing practice and have no complaints. 

 

Thanks for explaining that to me Marisa.

[Marisawright]

27 minutes ago, MARYROSE02 said:

Thanks for explaining that to me Marisa.

I was actually explaining it to Wanderer.   By the way, @MARYROSE02, I can't understand why you're having colonoscopies every 3 years if you've never had a polyp yourself.   

I had a polyp, and worse than that, it was pre-cancerous.   After that, I had a colonoscopy 3 years later, and they found another really tiny one, then again 3 years later and it was all clear.  So, having established that my polyps grow slowly, I now get checked once every 5 years.  And remember, I had a polyp that was very close to being cancerous.  So why you'd need them every 3 years if you've never had a polyp,  I don't understand.   

[Wanderer Returns]

3 hours ago, Marisawright said:

It's not odd, it's business.  Dr Dougster shot me down for this before, but the point is that GP's run their own businesses.  Some will choose to run a more personalised, boutique service  where others will go for a low-cost, quick-service option.  What they charge will vary accordingly.   

As Quoll said, the original idea of Medicare was not to dictate to GPs what they should charge (because they are independent businesses, so that wouldn't be appropriate).  The doctor set their own fees, the patient paid it, and claimed some of it back from Medicare.

Then along came the big companies, who built big medical centres.   They had economies of scale - employing a large number of doctors in one place with shared support staff.  Bulk-billing meant drastically simplified accounting and administratoin which saved more costs.  Then all they had to do was churn patients through on short appointments. The focus was very much on profits, and anyone who could afford a "proper" doctor avoided them!  Eventually there was a shakeout in the industry and I don't think that kind of shonky practice goes on now.  I go to a bulk-billing practice and have no complaints. 

Very good explanation - thanks Marisa. I started this topic because I found it curious that most of the doctors where I'd been living in Wynnum seemed to bulk bill, whereas up here on the Sunshine Coast the opposite appears to be true. I thought I'd look up the statistics (maybe I should've done that in the first place) and according to the Department of Health, 86% of all GP visits in 2019 were bulk-billed.

https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/medicare-bulk-billing-rate-of-86-per-cent-for-2019#:~:text=Australians continue to visit their,for the 2019 calendar year. 

The government seem quite proud of this figure, boasting that it was higher than the pervious labour government, so it would seem their intention is to give everyone access to free health care, should they choose.

[Wanderer Returns]

4 hours ago, MARYROSE02 said:

I never thought about that to be honest. I just assumed it was like in the UK where, unless it has changed since I was there, there is no means testing when you go to see a GP?

In principal it hasn't changed, but in practice you now need to wait much longer for an appointment in most areas. The average waiting time is now a couple of weeks. My wife once had to wait up to 2 weeks on one occasion, although usually it was between 5 and 10 days because we used to be on the lookout for cancellations, online. Often by the time you got to see a doctor the problem had either subsided, or got worse to the point where you'd need to attend A&E - another four-hour wait. Either way, you'd probably have been in discomfort for some time, and tried to find a cure yourself on Google. After buying a property we moved about 1km, and we were no longer allowed to attend the surgery we'd been going to for years because we weren't in the catchment area. Visiting the doctors' here is like a breath of fresh air by comparison. 

Edited December 19, 2020 by Wanderer Returns

[Paul1Perth]

11 hours ago, Quoll said:

The big medical centres tended to set up in high population areas so they could get the numbers churning through so country towns dont make it viable for them and country folk have to do the co-pay, if, indeed they can find a doctor at all!  Canberra isnt that well endowed with bulk billing options - it used to be nigh on impossible to get a high needs person - like a drink/drug addict seen by a bulk biller and that was a bone of some contention amongst support services..

In my opinion drink/drug addicts should be paying something towards their treatment. 

[MARYROSE02]

23 hours ago, Marisawright said:

I was actually explaining it to Wanderer.   By the way, @MARYROSE02, I can't understand why you're having colonoscopies every 3 years if you've never had a polyp yourself.   

I had a polyp, and worse than that, it was pre-cancerous.   After that, I had a colonoscopy 3 years later, and they found another really tiny one, then again 3 years later and it was all clear.  So, having established that my polyps grow slowly, I now get checked once every 5 years.  And remember, I had a polyp that was very close to being cancerous.  So why you'd need them every 3 years if you've never had a polyp,  I don't understand.   

I went with my surgeon's recommendation. I don't know if his recommendation was sound or whatever the phrase if for generating work which is not necessary. I just assumed I was supposed to have one every three years. My GP here seemed puzzled as to why I wanted a colonoscopy but he referred me to a specialist. When I saw him he did not seem to think that I needed a colonoscopy but my GP got me to do the poo test. I get the result next week I think.

I think you are probably right with your assessment. I know a guy here who told me he goes every five years and his father had bowel cancer. Him telling me that was another "red flag" that I might not need them.

Of course, on the other hand, there are the many people who for one reason or another refuse to do the poo tests which the Commonwealth government sends out free to, I think, everybody over 50? I imagine those reasons for not doing it might include distaste at having to "play with your poo?" Fear of what might be found? I don't know.