Tue Feb 25

The major parties want 9 in 10 GP visits bulk billed by 2030. Here’s why we shouldn’t aim for 100%

Written by Yuting Zhang, Professor of Health Economics, The University of Melbourne

Unaffordable GP visits has become a pressing issue amid the increasing cost-of-living crisis. About 30% of Australians delayed or didn’t see a GP ^[1] in 2023–24.

To solve this problem, Labor has proposed extending bulk billing incentives to all Australians. It hopes to increase bulk billing from 78%^[2] to 90% by 2030.

The Coalition has promised to match Labor’s plan.

Why not aim for 100%? It might seem a worthy goal to make GP care free for everyone, for every visit. But the evidence suggests there’s benefit to getting those on higher incomes to contribute a small amount to the cost of seeing a GP.

GP care should be free for these Australians

We should aim for access to GP care to be affordable and equitable. For some people, this should mean they can access the services for free.

Appointments for children should be free. Making health checks regular and accessible during childhood is an effective long-term investment ^[3] which can delay the onset of disease.

GP visits should also be free for people with low incomes. Free primary care can mean people who would otherwise avoid seeing a GP can have their ongoing conditions managed, undergo preventive health checks, and fill prescriptions.

When people skip GP visits and can’t afford to fill their prescriptions, their conditions can worsen. This can reduce the person’s quality of life, and require higher-cost emergency department visits and hospital care ^[4].

Appointments in rural and remote areas should also be free. Australians living in rural and remote areas currently pay more to see a GP, have less access ^[5] to care when they need it, and experience poorer health outcomes and shorter lives ^[6] than their city counterparts.

Making GP visits free for rural and remote Australians would help reduce this rural–urban gap ^[7].

Rural Australians find it harder to see a GP when they need one. Michael Leslie/Shutterstock ^[8]

However, providing free GP care for everyone can cause unnecessary strain on health budgets and make the policy unsustainable in the long run.

What can happen if you make care free for all?

In general, when the price is low, or something is free, people use these services more ^[9]. This includes medical care and medications ^[10]. Free GP care may encourage more people to see their GP more than is necessary.

Previous research showed that free care increased the use of health care but does not necessarily improve health outcomes, especially for those who are relatively healthy ^[11].

If people are using GP services when they’re not really needed, this takes limited resources from those who really need them and can increase waiting times.

Australia is already experiencing ^[12] a GP shortage ^[13]. Higher patient volumes could leave existing GPs overwhelmed and overstretched. This can reduce the quality of care ^[14].

Countries that have made primary health care free for all, such as Canada and the United Kingdom ^[15], still report issues with access and equity. In Canada, 22% of Canadian adults do not have access to regular primary care ^[16]. In the United Kingdom, people who live in poor areas struggle to get access ^[17] to care.

Make co-payments more affordable

To balance affordability for patients with the financial viability of primary care, Australians who can afford to contribute to the cost of their GP care should pay a small amount.

However, the A$60 many of us currently pay ^[18] to visit a GP is arguably too expensive, as it may prompt some to forego care when they need it.

A relatively smaller co-payment in the range of around $20 to $30 to visit the GP would help discourage unnecessary visits when resources are limited, but be less likely to turn patients off seeking this care.

Providing free GP visits for all may not be efficient or sustainable, but making it more affordable and equitable can lead to a more efficient and sustainable care system and doing so is within our reach ^[19].