The bulk billing crisis is widening the urban-rural gap in access to medical services

Snow said wait times in Bendigo have also skyrocketed. Most medical clinics can no longer afford wholesale billing, and those that can can no longer accept new patients. His clinic recently stopped bulk charging primary school children and the local community health center was forced to introduce differential payment for some services.


Medicare reimbursements were frozen by Labor in 2013 and kept unchanged by the Coalition until a 1.6% increase this year.

GPs say the amount reimbursed to them by the government is not enough to cover their costs, including soaring rent, medical insurance, salaries and supplies. A growing number of people who previously billed all consultations en masse are now charging patients a variance fee.

Yousuf Ahmad runs the Inglis Medical Center in Sale, the only respiratory center for tens of thousands of people. Extreme demand means many of his patients are waiting up to five weeks for appointments.

The GP is troubled by soaring rates of advanced skin, breast and colon cancers he is diagnosing in people who have deferred healthcare during the pandemic.

Access to bulk billing and GPs in rural Victoria

Mildura: Fifteen thousand patients left without a wholesale billing doctor after Tristar Medical Group went into voluntary administration. Nearby clinics have wait times of two weeks for existing patients and eight weeks for new patients.

Bairnsdale, East Gippsland: The Association of Rural Doctors says people wait at least four weeks to get an appointment with a GP. Most clinics are no longer taking new patients.

Bendigo: Doctors say most medical clinics can no longer afford wholesale billing, and those that can cannot accept new patients. Some clinics have now stopped charging elementary students wholesale.

Sale: Inglis Medical Center is the only respiratory clinic for thousands of people. Extreme demand means many patients are waiting up to five weeks for appointments.

Mallacoata: Bulk billing has been reduced to healthcare cardholders and will soon charge fees to most patients. The nearest wholesale billing clinic is 85 kilometers away in Eden, New South Wales.

Wangaratta: Group billing of three of the seven medical clinics. Some patients are waiting two to three weeks for appointments, and new patients are having trouble getting appointments. Veteran doctors say their patients are waiting eight to 12 weeks for routine checkups.

Ahmad still wholesale charges for patients under 15, those over 65 and a tidal wave of patients with mental health issues. But its workforce has tripled during the pandemic. His clinic is no longer financially viable and he may have to stop wholesale billing.

“We care so much about our community, but we can’t continue to operate this way,” he said.

Around 15,000 patients were left without a wholesale billing doctor in Mildura after Tristar Medical Group, which had a GP clinic, went into voluntary administration last month.

Tristar, which had clinics across regional Australia and is known for hiring international medical graduates to staff regional towns, has several unpaid creditors and has been struggling financially for years.


Marie Marasco’s daughter, Maya, 17, a former Tristar patient, has recurrent tonsillitis but cannot get an appointment with another Mildura clinic. She is on waiting lists of up to six weeks.

Marasco said her daughter was on repeated antibiotic scripts, she feared she would miss more school, and the family felt rejected and stressed.

“It needs to be fixed,” she said. “We need doctors.”

The college of general practitioners is pushing for Medicare reimbursements to be immediately increased by at least 10%, especially for patients with complex needs requiring consultations lasting more than an hour.

Medicare reimbursement for a standard consultation is approximately $39.75. That’s less than half of what the Australian Medical Association recommends for short consultations and the lobby group suggests the fee should be closer to $86 – a position backed by the college.

Karen Price, President of the Royal Australian College of General Practitioners.Credit:Alex Ellinghausen

Price called for urgent reform, including increased investment in general practice and an end to decades of using health as political football.

“It’s so toxic and it really hurts Australians’ ability to receive health care,” she said.

Murray Primary Health Network chief executive Matt Jones said talks had begun about short-term telehealth solutions and that a response to the crisis could involve Mildura GPs working after hours.

In Wangaratta, some of Dr Kate Davey’s patients wait between eight and 12 weeks for routine checkups, while two doctors are on call to treat patients in need of urgent care.

“We’re all trying to make it work so people don’t have to wait that long, but it’s extremely difficult,” said the 40-year-old GP. Of Wangaratta’s seven medical clinics, only about three now charge wholesale.

Davey said she was concerned not only about deteriorating patient health, but the increase in mental health presentations, noting that “almost every consultation now has a degree of mental health.”

In the town of Mallacoota in East Gippsland, bulk billing was made available following the 2020 Black Summer fires, but most patients will soon be charged a fee.

“We are in a situation where we are generating losses again, so it is just out of necessity,” said clinic owner Sara Renwick-Lau, acknowledging that some patients would have to travel to Eden in New Wales. South to access a wholesale billing clinic.


This week, the governments of NSW and Victoria revealed that each state would establish 50 bulk-billed urgent care clinics which would be run by GPs in existing clinics as part of a pre-election pledge by the federal government.

The announcement drew skepticism from rural doctors. So far, only about five clinics are in regional areas of Victoria and Phair fears that the rural towns that need the clinics the most are being left out.

“They just won’t have the staff to run these clinics,” he said.

Federal Health Minister Mark Butler blamed the previous government for nine years of “cuts and neglect”. Butler said the Albanian government is committed to improving general medicine and health insurance, investing nearly $1 billion in the sector.

This includes $750 million over three years through a new Medicare Strengthening Fund and an additional $146 million in new initiatives to provide more doctors to regional and rural Australia.

“The former government froze Medicare reimbursement for six years, ripping billions of dollars out of primary care and skyrocketing differential fees,” he said.

While GPs are largely a federal responsibility, the Victorian government is also desperate to address the crisis, pumping more than $14 million into a rural doctor recruitment scheme and tripling financial incentives to encourage foreign health workers to work in the regions. He also invested $12 billion in the state’s pandemic recovery plan, which includes a goal to hire 7,000 more healthcare workers.

But there are no easy solutions. Phair said better coordination between the two levels of government and addressing and disparity between healthcare workers in Melbourne and rural areas was key. He said universities had an ethical responsibility to look at how many medical students ended up in rural areas and whether they were accepting enough locals – a stronger predictor of them returning to work there.

More financial incentives were also needed, but he said while such measures worked to attract locum doctors, most did not engage in long-term rural careers and labor shortages existed. decades before the coronavirus.


“We need massive cultural change and health reform where the most disadvantaged communities with the worst health outcomes, like Mildura and Bairnsdale, are prioritized, and the best industry arrangements are given to these healthcare workers,” Phair said. “Rather than all of these resources continually going to people in the great Melbourne metro.”

The hospital crisis erupted again this week following the death of a 70-year-old woman who died of a heart attack while waiting for hours for an ultrasound at Latrobe Regional Hospital.

Earlier this year, a one-year-old girl infected with coronavirus died in the emergency department of Geelong University Hospital and a man died after hours of waiting for admission to Bairnsdale Regional Health Service during of an understaffed shift.

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