Bulk-billing rates are up. But there’s more to delivering the best possible care
- Written by Peter Breadon, Program Director, Health and Aged Care, Grattan Institute
A multi-billion dollar boost to GP funding has lifted bulk-billing rates[1] across the country, especially in many areas that need fee-free care the most.
But the changes prop up a dysfunctional funding model[2] for general practice, and have removed the main way the government pays more to GPs with poorer patients.
So deeper reform is needed.
What’s changed?
GPs get an extra Medicare payment (or incentive) to bulk bill a patient. This is on top of the existing rebate they’d usually receive.
In 2023, the government tripled[3] the incentive, which applied to concession-card holders and children. Then, in a flagship 2025 election pledge[4], the government said it would push the bulk-billing rate up to 90% by 2030.
To help get there, the government said it would expand the bulk-billing incentive to all patients[5], not just children and concession-card holders.
As a sweetener, clinics that bulk bill all their patients would get an extra 12.5%[6] on top of their Medicare payments.
Those changes kicked in from November 2025 and will cost taxpayers roughly A$2 billion[7] a year.
How much did bulk billing rise?
Data released this week[8] show there was an immediate impact.
From November 2025 to January 2026, 81.4% of GP services were bulk-billed, up from 77.1% for the same period a year earlier.
It’s the biggest quarterly increase since the early days of the pandemic. But the bulk-billing rate hasn’t returned[9] to the peak we saw then – when it reached over 90% – or the mid-80% range for several years before that.
The number of clinics that bulk bill all their services has also increased[10]. That’s from roughly 2,300 before the November changes, and more than 3,400 at the end of January.
Who’s benefiting most?
Bulk-billing rates have gone up in every state and territory, with the biggest increases for people aged 16–64, and those in regional centres and towns, and less-wealthy areas. That makes sense, given how the bulk-billing incentives have been designed, and changed.
The bulk-billing rate[11] of people aged 16–64 shot up 4.2 percentage points, a far bigger change than any other age group. That’s because they are newly eligible for the incentive even if they don’t have a concession, and they’re less likely to have a concession than older people.
The incentive for GPs to bulk bill goes up as you move out of major cities. In cities, the incentive for a face-to-face consultation longer than five minutes is $21.85[12]. In very remote areas it rises to $42.05[13].
In poorer areas, clinics tend to have lower fees and more bulk billing. That means they are more likely to profit if they switch to take advantage of the new incentives.
The average GP fee in the December quarter was $51[14], up from $48 a year before, after adjusting for inflation.
What’s missing?
This huge investment is having its intended impact. Each week[16] more clinics are choosing to bulk bill all their patients.
But boosting bulk-billing incentives has a side-effect: entrenching a dysfunctional[17] funding model.
Australia relies mostly on fee-for-service payments for general practice. That means more funding for many short visits, regardless of a patient’s needs.
This also means money can’t flow through to a multidisciplinary team that works with a GP, and might include nurses, physiotherapists, psychologists and pharmacists.
The result is GPs rushing through visits with too little support. It’s a poor fit for complex chronic disease, and the fact that more Australians are living with multiple conditions, such as diabetes, hypertension and heart disease. This funding model also doesn’t channel money to where it’s needed most.
In one important way, changes to bulk-billing incentives make the problem worse. Previously, the incentive only applied to concession-card holders. But now GPs get the same incentive to bulk bill whether a patient is wealthy or poor.
This makes Australia unusual. Other high-income countries adjust GP funding for disadvantage, which is strongly linked to the need for care.
How do other countries do it?
Starting from this year, New Zealand[18] will pay GPs more for seeing disadvantaged patients. Scotland[19] did it in 2018. They followed many other systems from Sweden to Canada.
England’s approach has long been criticised[20] for not doing enough to take disadvantage into account in GP funding. But the government is reviewing[21] funding to change that.
Back in Australia, two independent[22] reviews[23] commissioned by the federal government, along with Grattan Institute research[24], have recommended Australia catches up with other countries and make general practice funding fairer.
They have called for “blended funding”: combining a flexible payment based on each patient’s needs with a fee for each visit.
What’s next?
The government is celebrating this spike in bulk billing, and patients will welcome more fee-free GP visits. While there are signs the gains will be sustained, it’s too early to tell for sure.
Either way, Australia can’t just keep tipping money into the wrong way of funding care. Even if we reach the 90% bulk-billing target, other changes will be needed for funding to reflect patients’ health and wealth. That’s essential for making our health-care system effective and fair.
References
- ^ lifted bulk-billing rates (www.health.gov.au)
- ^ dysfunctional funding model (grattan.edu.au)
- ^ tripled (www.mbsonline.gov.au)
- ^ election pledge (www.health.gov.au)
- ^ to all patients (www.mbsonline.gov.au)
- ^ an extra 12.5% (www.health.gov.au)
- ^ A$2 billion (budget.gov.au)
- ^ Data released this week (www.health.gov.au)
- ^ hasn’t returned (www.aihw.gov.au)
- ^ increased (www.health.gov.au)
- ^ bulk-billing rate (www.health.gov.au)
- ^ $21.85 (www9.health.gov.au)
- ^ $42.05 (www9.health.gov.au)
- ^ $51 (www.health.gov.au)
- ^ CC BY (creativecommons.org)
- ^ Each week (www.markbutler.net.au)
- ^ dysfunctional (grattan.edu.au)
- ^ New Zealand (www.health.govt.nz)
- ^ Scotland (www.gov.scot)
- ^ criticised (www.health.org.uk)
- ^ reviewing (www.gov.uk)
- ^ independent (www.health.gov.au)
- ^ reviews (www.health.gov.au)
- ^ research (grattan.edu.au)
