Bulk billing

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Bulk billing is a payment option under the Medicare system of universal health insurance in Australia. It can cover a prescribed range of health services as listed in the Medicare Benefits Schedule, at the discretion of the health service provider.[1] The health service provider, usually a doctor is paid 85% of the scheduled fee for outpatient services; and 75% of the scheduled fee for inpatient services, by billing the government via the patient's Medicare card. The service provider receives a fixed proportion of the scheduled fee but avoids the costs and risks of billing and debt collection. It could be described as a form of factoring.

Bulk billing rebates may be collected and paid directly to the service provider, or the service provider may collect the equivalent fee from the patient; leaving the patient to claim the rebate online, over the telephone, by mail, or at a Medicare office. Increasingly, service providers offer electronic lodgement at the practice using EFTPOS.[2]

Under Medicare, it is not permissible to charge the patient a co-payment with bulk billing (although this was previously permissible): a service provider who bulk bills for a service may not charge the patient further for that service.

Service providers may choose whether or not to use bulk billing. Many general practitioner services are bulk-billed, but less so in more affluent areas and in rural, regional and remote areas of Australia where there is a greater shortage of doctors and health care services. The key purpose of bulk billing is to provide an economic constraint on medical fees and charges.

2014 co-payment proposal[edit]

In the 2014 Australian federal budget, the Abbott Government proposed to impose a $7 co-payment for all bulk billed GP and medical test visits. The proposal was to reduce the medicare rebate payable to service providers by $5 (which applies to all consultations, and not just bulk billed ones) with the additional $2 paid by patients also going to providers. Initially, there was no option for bulk billers to opt out of the co-payment. $20 billion gathered from the $5 reduction in the rebate are to be designated to funding a new Medical Research Future Fund.[3] The co-payment measure was initially recommended by the National Commission of Audit and adopted as a government measure in the 2014 federal budget, to commence from 1 July 2015.

The co-payment has been described as a rationing measure to decrease the number of unnecessary medical consultations,[4] but was to apply on all consultations including those by critically ill patients, pensioners and others, and are cumulative with no threshold limits. The proposal has been widely criticised.[5]

Prime Minister, Tony Abbott announced in December 2014, that the co-payment will be reduced to $5, with application to all patients, with practitioners having an option not to pass on the $5 to patients. Children, pensioners, veterans and aged care residents are to be exempted from the rebate reduction.[6][7]

In March 2015 the Health Minister Sussan Ley announced that "we are not pursuing it at all" with Prime Minister Abbott declaring the co-payment was "dead, buried and cremated".[8]


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