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Bulk‐billing rates and out‐of‐pocket costs for general practitioner services in Australia, 2022, by SA3 region: analysis of Medicare claims data

Karinna Saxby and Yuting Zhang
Med J Aust || doi: 10.5694/mja2.52562
Published online: 27 January 2025

Abstract

Objectives: To examine bulk‐billing rates and out‐of‐pocket costs for non‐bulk‐billed general practitioner services in Australia at the Statistical Area 3 (SA3) level; to assess differences by area‐level socio‐economic disadvantage and remoteness.

Study design: Retrospective analysis of administrative data (Medicare claims data).

Setting, participants: All Medicare claims for non‐referred general practitioner services in Australia during the 2022 calendar year, as recorded in the Person Level Integrated Data Asset (PLIDA).

Main outcome measures: Mean proportions of general practitioner services that were bulk‐billed and mean patient out‐of‐pocket costs for non‐bulk‐billed general practitioner visits by SA3 region, adjusted for area‐level age and sex, both overall and by area‐level socio‐economic disadvantage (Index of Relative Socioeconomic Disadvantage quintile) and remoteness (simplified Modified Monash Model category).

Results: During 2022, 82% (95% confidence interval [CI], 80–83%) of general practitioner services in Australia were bulk‐billed; the mean out‐of‐pocket cost for non‐bulk‐billed visits was $43 (95% CI, $42–44). By SA3, mean bulk‐billing rates ranged between 46% and 99%, mean out‐of‐pocket costs for non‐bulk‐billed general practitioner visit between $16 and $99. Bulk‐billing rates were higher in regions in the most socio‐economically disadvantaged quintile (86%; 95% CI, 84–88%) than those in the least disadvantaged quintile (73%; 95% CI, 70–76%); the mean rate was not significantly different for remote (86%; 95% CI, 79–92%) and metropolitan areas (81%; 95% CI, 79–83%). Out‐of‐pocket costs for non‐bulk‐billed general practitioner services were higher in remote ($56; 95% CI, $46–66) than in metropolitan areas ($43; 95% CI, $42–44), and lower in areas in the most socio‐economically disadvantaged quintile ($42; 95% CI, $40–45) than in those in the least disadvantaged quintile ($47; 95% CI, $45–49).

Conclusion: Although most general practitioner services are bulk‐billed, out‐of‐pocket costs for non‐bulk‐billed services are relatively high, particularly for people in remote and socio‐economically disadvantaged areas of Australia.


  • Melbourne Institute: Applied Economic & Social Research, The University of Melbourne, Melbourne, VIC



Data Sharing:

The Person Level Integrated Data Asset Data used for our analysis are available upon request to the Australian Bureau of Statistics.

Acknowledgements: 

We thank the Australian Bureau of Statistics microdata team for their tireless vetting and assistance. We also thank Susan Mendez (Melbourne Institute, University of Melbourne), Dennis Petrie (Centre for Health Economics, Monash University), and the participants of the Medicare at 40 Event (Canberra. 19 February 2024) for useful feedback and suggestions. Yuting Zhang holds an Australian Research Council Australian Future Fellowship (FT200100630).

Competing interests:

No relevant disclosures.

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