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

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.