Australia’s Bulk Billing Explained and $7 GP Fee Co-payments

my doctorOne of the main concerns for anyone considering moving to Australia, especially those who aren’t so young, is the cost of health services here.

As you know, we had a federal budget not so long ago which I wrote about in my post The Misery Index 2013: a Response to Australia’s Budget. Top of my budget highlights was the additional $7 fees applicable for visiting a doctor or pathology and imaging services.

This proposed additional fee does not kick in until 1 July 2015 and will also have to pass through Senate first, but it’s already causing a bit of a hullabaloo.

But what does it all mean? Before that though:

What is ‘bulk billing’?

It’s complicated, very complicated. Here’s what I mean:

  • Check out Wikipedia for the complicated short version
  • Check out Medicare for the complicated long version

See what I mean?

I’m going to try and summarise it to something that is short and comprehensible.

Bulk Billing Explained

This is such a simplified version that it cannot possibly cover everything, or even be technically correct, but I think it’s all we need to know as patients visiting doctors. So, let’s just call this a patient’s guide to understanding bulk billing.

  • Doctors can set their own consultation fees; mine charges $80, for example
  • Medicare give patients a rebate on that fee, currently $36.30
  • When I first arrived in Australia, I would pay my doctor’s receptionist in full after a consultation and be given a receipt
  • I would take that receipt to the nearest Medicare office (or go online) to claim my rebate and Medicare would give me $36.30 back
  • These days that system has been refined at the doctor’s surgery; I pay my doctor’s receptionist the $80 in full, then I present my Medicare card which gets swiped and I am immediately paid my rebate of $36.30 direct into my bank account the very same day. Far more convenient.

But that ISN’T bulk billing.

Bulk billing is where:

  • The doctor charges a consultation fee of $36.30
  • The patient presents their Medicare card to the receptionist
  • Medicare deposit $36.30 direct into the doctors account
  • The doctor is not allowed to charge any additional fees
  • The patient has seen the doctor at no cost whatsoever

The proposal is that these patients need to pay $7, so no more free visits.

Government says this additional payment is required to keep the health service sustainable. Their concern is that people who pay nothing would be tempted to visit their doctor unnecessarily. You know the sort of thing; “Doc, whenever I watch the news on TV, my teeth itch” or “Doc, if I put my arm out straight in front of me holding a can of peas, it really aches after a couple of minutes.

Yes, ridiculous examples, but I’m sure some people do visit doctors for quite ridiculous reasons, we’ve all seen Doc Martin, and that puts a burden on the system.

The other side of the coin though is that some people do genuinely need to visit the doctors regularly, diabetics for example.

money bagWho pays this $7 co-payment?

It’s complicated, very complicated. Here’s what I mean:


Actually, that is no longer a link to what the Australian Medical Association have to say, because they’ve taken it down. The $7 co-payment idea was scrapped, but I’ve left a link up to the AMA’s homepage because if you search for ‘co-payment’ you will find there are still other schemes and ideas being kicked around.

On with the article…

At this stage though, there’s little point in trying to analyse those details as this $7 GP fee has not yet come into force. From what I have read though, it’s not just those who were getting ‘free’ bulk billed visits who have to pay, everyone will be charged except those on concessions.

For example, I currently pay $43.70, under the new scheme I would pay an additional $5 which would go direct to government. So it appears that most people will be paying more to see their doctor.

There’s a lot of debate and opposition to this idea though and it has yet to pass through Senate; that’s totally different to how it worked back in the UK.

In the UK, the government would announce its budget and that was that. It was a done deal. Here though, the final say belongs to Senate as you know from my post Australian Politics Explained.

Whether this GP fee comes into force or not, we will see. One thing is for certain though, if it doesn’t, I’m sure the government will get the money out of us from somewhere else.

This has been a complicated subject and another one of those posts that have given me quite a headache to write. I may need to go to the doctors. But if I’ve made any glaring errors or if I’ve misunderstood anything in this process, please do feel free to tell me in the comments below.

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{ 21 comments… add one }
  • Trevor March 28, 2018, 7:02 am |

    The British NHS (National, Notional? Health Service) is falling apart as it attempts to become the ‘World Health Service’ to the flotsam and jetsam which are readily accepted by family doctors once inside the country. A Nigerian woman, pregnant with quads (2 died) after fertility treatment at home, who carefully timed her travel to go into labour on British soil, cost taxpayers £500,000 which will never be repaid. This was after being refused entry to the USA for not having health insurance. Any developed country would never have permitted boarding to a heavily-pregnant lady, for her own health as well as airline regulations.

    If an NHS hospital department, such as the pain clinic, is short-staffed, or swamped with patients, they merely impose a rule that only other hospital consultants can refer patients, not the general practitioner (family doctor) who made the original diagnosis. Or one could go private and pay a huge consultation fee — but don’t expect any refreshments whilst awaiting the specialist who is running 40 minutes late … although his secretary will plonk a steaming-hot cup of coffee (for him) on his desk, without so much as asking the patient if he would like one too. ‘Bizarre’, as my GP described it.

    A twist is that the private pain specialist also does NHS work and may offer to treat British residents absolutely free, saving them a fortune in costs. However, such appointments can easily take 3 to 6 months to come through as the NHS admin staff are terminally slow and inefficient, and only threats to invoke the intervention of one’s Member of Parliament seem to have any effect on speeding matters up.

    Meanwhile, ordinary patients struggle to see their preferred doctor within a month for routine appointments. The crafty just lie and say it’s urgent. The GP is gatekeeper to all specialist treatments, whereas in other countries the patient can approach the specialist directly, saving time, pain and distress. If an NHS patient, in regular attendance to appointments lasting the nationally-mandated 10-minutes, and on regular prescription repeats, suddenly drops off the radar and fails to attend or request medication, they are totally ignored. A example might be this pensioner with known health issues who lay dead-and-rotting at home for 2 years until discovered by bailiffs …

    When I attempted to get my GP practice to monitor me as a vulnerable patient, at least phoning me if I failed to make my prescription or consultation request as usual, I was threatened with removal from the practice for being rude to the receptionist. Curiously this was by a rare Australian-born GP in the U.K. — the type who love plastering surgery walls with warning notices that the police will be called if any threatening behaviour is made by patients (even though they may be sick, stressed, or on mood-altering medication). Further enquiries revealed that neither NHS, nor private doctors were under any obligation to monitor outpatients and that a change in the law would be required. Does Australia have any such monitoring system, such that single people at least have a chance of being discovered and don’t need to decay at home for 2 years after death?

    • BobinOz March 28, 2018, 7:13 pm |

      Yes, I do keep in touch with the news in the UK and there is much talk about the failing NHS system at the moment, there are even suggestions that they have run out of money.

      Here though, I have to say, our Medicare system appears to be working very well. It’s our public health system which is funded by 2% levy on our income. Where I live, I don’t have any problem seeing a doctor, and I get my appointment most usually the next day or within two days. I can also vouch for the public hospital system here, in particular the RBWH in Brisbane, they are fantastic.

      As for home monitoring, I’m not sure that does happen here, although I do know some big companies are working on artificial intelligence monitoring systems and I’m sure many people are already using those in their homes, not just in Australia, but all around the world.

      • Trevor March 28, 2018, 11:41 pm |

        Germany spends 50% more on its public health service than the UK, which says a lot. One problem is the Brits are used to not paying for health care, apart from their subsidised drug prescriptions, so have no idea of the true cost as co-payments and deductibles indicate elsewhere.

        My hospital pain clinic appointments, whether in Cambridge or London, always seem to fall into a black hole from which the patient liaison office has to rescue them. Problems seem to be inefficient staff, personnel handling your case on annual leave, the sheer volume of patients & workload for the doctors, and even equipment failures like: ‘Our fax machine was out of order then’.

        Often the patient who, by definition, is not usually firing on all cylinders, is the only one to spot that someone has dropped the ball, sending their case into the NHS’s insatiable black hole. Fortunately a dribble of Hawking Radiation does escape but even this requires professorship-level education to retrieve. Notifying one’s member of parliament can help but it’s hardly fair use of their time chasing clerical matters.

        • BobinOz April 2, 2018, 6:02 pm |

          Sounds like hard work, and although I wasn’t expecting it, I actually think the Australian healthcare system is better than the NHS, even though sometimes some things have to be paid for.

  • Matt October 17, 2016, 8:38 pm |

    Hi bob,

    Interesting to hear your analysis of the woes of the Australian Medicare system but having lived in the UK for 6 years I can say i would by far prefer the Australian system. My reasons for this are as below:

    1. It is possible to visit the GP at no cost.(same for both countries)
    2. Under the Australian system, if I don’t like the service or diagnosis I received from one particular doctor, I am free to go to any other doctor on the country, show my Medicare card, and receive a second opinion. Or a third. Or a 4th. In the UK, I was effectively assigned a doctor based on my postcode, had to register with that doctor and wait for all my history to be transferred from my former GP before I could seek an appointment, and if I wanted a second opinion I had no choice but to a) go through the process of transferring to another GP and waiting for all my records to be transferred again or b) pay a private doctor.
    3. I have never had an Australian doctor tell me there is a “5 minute limit – one ailment only” per visit. The Australian Medicare system pays the doctor a sliding scale based on the amount of time you spend with them – so no need to keep leaving and coming back, and providing you are visiting a doctor who bulk bills (which at least 60% do), I will still never receive a bill.

    The one thing I -will- say in defence of the U.K. System is that as a privately insured patient, I received far better treatment in the UK than as a privately insured patient in Australia. In the UK, I was given preferential treatment, reduced waiting times, choice of surgeon, and -no cost- whatsoever for treatment. In Australia, with private health insurance I received preferential treatment, reduced waiting times, choice of surgeon, but would always end up with a huge bill of between 60-80% of costs out of my own pocket – despite paying private insurance premiums and the insurer paying in accordance with their payout schedule.

    Ie, the U.K. System of “no gap” private insurance is truly “no gap” and therefore very attractive when compared with a very lean free system. In Australia, the private system is riddled with extras and hidden costs – but the free system is exceptionally good. Which is why most Australians have private health insurance (because our tax system penalises us if we don’t), but we prefer to seek treatment under the public system at no cost until faced with a serious illness. Unfortunate but true.

    • BobinOz October 18, 2016, 6:56 pm |

      Hi Matt

      Firstly, thank you for an excellent round up and comparison of the health services in both the UK and Australia. I am in absolute agreement with you on everything you have said, you are spot on with your analysis.

      Having experienced the health services in both the UK and Australia, I too prefer the Australian system. In fact I don’t have any woes at all with it, I think the way they do things here is surprisingly good.

      You have covered everything very well, I would just like to add that one major difference here is that even if you are using the public health system, if you need an x-ray, a scan of some sort or an MRI, you will have to pay but you’ll get about half of it back through Medicare as a refund. In the UK, these kinds of scans are usually free, but you do have to wait at a hospital for your turn, whereas here you make an appointment at any one of the many diagnostic centres sprinkled around the suburbs, turn up, and you are usually in the out within half an hour.

      I’m more than happy to pay the money here and save all that time rather than getting it free in the UK.

      As for private healthcare, I don’t have a major policy, like you say, you do end up paying a lot of extras, insurance doesn’t cover everything. I wrote about that recently after a major operation I had in hospital, privately, without insurance. Even then the money I saved by not paying insurance premiums for eight years since I got here easy covered the rather large bill.

      You can read it here:

      If there is anything you said that I’m not quite sure about, it’s that private healthcare might be worth signing up for just for the tax benefits. Even with the government chipping in whatever they do, I still don’t see the value.

      That aside, I’m with you all the way, I like the Aussie system and the freedom it gives us.

      Cheers, Bob

  • Hazel Owens March 2, 2016, 4:35 am |

    Thanks for the article; I heard about bulk billing in Australia, and I had no idea what it was. I still don’t have a super great understanding of it, but I understand bulk billing more than I did before! I do think that the $7 co-payment probably is a necessity for the reasons you mentioned; people visiting the doctor for no reason takes time and energy from those that have a need. It is definitely complicated, but I feel like I understand the basics better now.

    • BobinOz March 2, 2016, 4:49 pm |

      Well, it’s very easy to understand now Hazel, the $7 fee was scrapped before it even came into effect.

  • J October 12, 2014, 11:09 am |

    I’ve been going to my local GP
    who charges $65 aprox per visit .
    Just recently I visited another GP
    In the same area who bulk billed me .
    I would rather it done this way as if i need
    to see a doctor one day and I don’t have
    the funds at that time I can still get the
    medical attention I need.
    Why does one doctor bulk bill and the other
    doesn’t ? Who decides who will or won’t bulk
    The doctor at the second practice asked me
    why alot of the patients are transferring from
    first practice. Well who wouldn’t ? $65 vs
    $0-$7 – the quality of care was much the
    same .

    • BobinOz October 13, 2014, 4:21 pm |

      Why one doctor bulk bills and another doesn’t is exactly what’s answered in full in the above article, but the short answer is that your new doctor who does bulk bill is happy to work for the standard government fee, whereas other doctors charge more and the patient has to pay the difference.

  • Hilary June 22, 2014, 10:16 pm |

    Hi Bob

    At last – a clear explanation of Bulk Billing! Thanks so much, I’ve struggled to understand exactly how it works and even people I know in Aus haven’t been able to explain it so I understand. Was beginning to think it was just me not cottoning on – which is highly likely with the old grey cells vanishing by the second…

    Your site is a brilliant resource and much appreciated. Just love your sense of humour and when things are getting a tad overwhelming not to say daunting, I always end up laughing and feeling better for reading your comments and watching the vids. Keep up the good work, it’s helping so many of us, thank you.

    • BobinOz June 23, 2014, 11:41 pm |

      Glad to have cleared that up for you Hillary and really pleased to hear that you are enjoying my website.

      I’ll certainly keep up the good work, hopefully you will keep reading.

      Cheers, Bob

  • djmcbell June 16, 2014, 5:24 pm |

    Interestingly there has been talk recently in the UK of having to pay to make appointments with GPs. Don’t know how that one has gone as I think doctors were to vote on it recently, but it’s still free (well, at point of use) so I can just ring up, book an appointment, turn up and not have to pay (aside from prescriptions, of course).

    However, if only they weren’t so crowded – the local GP opens at 8am and, unless you’ve managed to get through by 8:15 (normally I ring just at 8 and the answer phone says they’re closed, ring 30 seconds later and I’m number 15 or more in the queue) then you’ve got no chance of the same day, and about a fortnight waiting if you want to book in advance. Not to mention the 0844 number they use costs a bomb.

    • BobinOz June 16, 2014, 8:37 pm |

      Yes, there’s a price to pay for not paying any price at all, and it’s time. I could go to a cheaper doctor if I wanted to, but one other things I really like about my doctor is I never seem to wait more than about 20 to 30 minutes in reception and it’s pretty easy to book an appointment.

      I’d much rather pay an extra $40 and waste two hours or more waiting.

      Maybe if they do introduce those fees in the UK some people might actually think it’s worth it.

      • Layla June 17, 2014, 6:05 pm |

        As someone who comes from the UK but spent 3 years in Australia (most of this on a student visa), I’d much rather pay, than wait 2 weeks for an appointment
        I paid $65 for an appointment at a city doctors in Perth, of which I got about $30 back from Medicare or my health insurance. And I always got an appointment the next day, usually.
        In comparison, back at home in the UK, getting Riverside Surgery in Shropshire to even answer the phone is a challenge in itself, then you have to break through the questioning barriers that the receptionists put up (Would you say it’s urgent?/Is it an emergency though?), ummm what?!
        Then after you’ve convinced them you really ARE sick, you get told you can have an appointment in two weeks.
        I’d rather pay more any day, an extra $7 bucks? So be it. I’ll still pay it happily than go back to that.

        • BobinOz June 18, 2014, 1:54 am |

          Ah, yes, I remember that, the challenge of telephoning the doctors in England. It’s engaged again, I’ll try later. It’s engaged again, I’ll try later. And on and on.

          And my doctors back in Essex had a sign at reception saying “If you have two ailments, please make separate appointments.”

          Here I can turn up with a list and go through it with a pen crossing them off and my doctor doesn’t care, he just works through it all with me.

  • Mark Pettitt June 10, 2014, 11:41 pm |

    Hi Bob, I’ve been looking at your site for some time now and regularly use it as a source of interesting and informative research. As luck would have it my parents emigrated to Aus for a period of around 4 years as £10 Poms, 2 years in to their stay, I made an appearance.
    After my daughter did a gap year over there last year, we have decided to take some time out of the UK and emigrate, albeit we are reluctant to sever all ties until we have lived and experienced what is on on offer, then we can make an informed decision. Given my birthplace, and a few enquiries, I am an Aussie citizen (much to my surprise after 40+ years of not knowing this or looking into before) and I now hold an Aus passport, so PR, as it transpires is an automatic right.
    My one fear is the point you make here, of being a Type 1 diabetic, I need a great deal of maintenance and medication from the NHS, but, fortunately, this is all provided FOC (excluding the obscene amount of tax that I’ve put into the system !!).
    I am struggling to find out how my care would be provided over there, how to register with the healthcare system and where the best resources are available for research online. My other lesser worry, but probably more important, is the standard of care that is offered, although I suspect this is most likely comparable with here in the UK.
    Any help or pointers you can give me would be gratefully received.

    • Amla June 11, 2014, 6:19 pm |

      Mark, I am an insulin dependent type 2 diabetic. I am a member of NDSS, which is the diabetics association and if you are registered with them you get major discounts on your diabetic meds, including glucometer strips and insulin pens.

      Hope this helps. 🙂

      • Mark Pettitt June 11, 2014, 7:21 pm |

        Thanks Amla, very useful I shall research the NDSS before leaving

    • BobinOz June 11, 2014, 6:22 pm |

      Hi Mark

      Well, I wish I could help, but I’d be guessing really, I have no experience in this area.

      I’m very confident you would get every bit as good care here as you currently do in the UK, I would say the only issue would be cost. As you can see from the above article, it’s possible you could find a bulk billing doctor and therefore have free doctors visits or pay the $7 should that get passed and become law.

      On top of that, you would need to pay for your (I assume) monthly prescription or ‘script’. For essential medication which no doubt includes scripts for diabetes, there is a subsidy, but you will still need to pay.

      I do know some subsidised prescriptions cost anything between $20 and $60 a month, maybe some cost much more, I don’t know.

      Have you tried asking the Diabetic Association of Australia? If you Google them, you should find them easy enough.

      As I’ve said though, I’m kind of guessing here, so I would try and do much more thorough research if I were you.

      Good luck, Bob

      Update: Amla and I are both added comments at the same time, so I didn’t see that one until I posted mine. Good information Amla, thank you.

      I have also now added an additional link at the foot of the above post with more useful information about Australia’s health services.

      • Mark Pettitt June 11, 2014, 7:24 pm |

        Thank you Bob, much appreciated

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