To the Editor: Equitable access to health care in Australia is facilitated by bulk-billing so that patients incur no out-of-pocket costs for medical services. From 1995 to 2001, there was a steady decline in bulk-billing of general practice consultations and rates of bulk-billing were lower for women living in rural areas than for those from urban areas.1 In 2004, Medicare incentives for bulk-billing were introduced — additional rebates for bulk-billed services provided to concession card holders or children under 16 years, and a higher rebate for services provided to eligible patients in rural and remote areas, selected metropolitan areas with a shortage of general practitioners or low bulk-billing rates, or anywhere in Tasmania.2,3 We assessed the bulk-billing rates for participants in the Australian Longitudinal Study on Women’s Health4,5 following the introduction of these items.
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- 1. Young AF, Dobson AJ. The decline in bulk-billing and increase in out-of-pocket costs for general practice consultations in rural areas of Australia, 1995–2001. Med J Aust 2003; 178: 122-126. <MJA full text>
- 2. Medicare Australia. Incentive payments to GPs who bulk bill concessional patients and children aged under 16 years. November 2005. http://www.medicareaustralia.gov.au/provider/incentives/files/incentive_payments_to_GPs_who_bulk_bill_concessional_patients_under_16.pdf (accessed Sep 2010).
- 3. Medicare Australia. HIC 2004–05 annual report. http://www.medicareaustralia.gov.au/about/governance/reports/04-05/index.jsp (accessed Sep 2010).
- 4. Brown WJ, Bryson L, Byles J, et al. Women’s Health Australia: establishment of the Australian Longitudinal Study on Women’s Health. J Womens Health 1996; 5: 467-472.
- 5. Lee C, Dobson AJ, Brown WJ, et al. Cohort profile: the Australian Longitudinal Study on Women’s Health. Int J Epidemiol 2005; 34: 987-991.
- 6. Australian Bureau of Statistics. Australian Standard Geographical Classification (ASGC), July 2010. Canberra: ABS, 2010. (ABS Cat No. 1216.0.)
- 7. Young AF, Dobson AJ, Byles JE. Health services research using linked records: who consents and what is the gain? Aust N Z J Public Health 2001; 25: 417-420.
- 8. Young AF, Dobson AJ, Byles JE. Determinants of general practitioner use among women in Australia. Soc Sci Med 2001; 53: 1641-1651.
- 9. Byles J, Loxton D, Berecki J, et al. Use and costs of medications and other health care resources: findings from the Australian Longitudinal Study on Women’s Health. Report prepared for Australian Government Department of Health and Ageing, June 2008. http://www.alswh.org.au/Reports/OtherReportsPDF/MajorReportC.pdf (accessed Sep 2010).
This study was conducted as part of the Australian Longitudinal Study on Women’s Health. We are grateful to the Australian Government Department of Health and Ageing for funding, to the women included for providing the survey data, and to Medicare Australia for providing the data on general practice consultations.