Inquiry to reflect on Medicare changes’ impact in the bush

Advocates for WA’s rural health workforce said they are yet to see a meaningful shift in access to primary care, despite the federal government’s overhaul of Medicare which included changes to bulk billing.

This comes as stakeholders prepare submissions as part of a federal Parliamentary inquiry into the matter.

“From what we’re hearing so far from rural general practices, the Medicare bulk-billing incentive changes introduced on 1 November haven’t meaningfully shifted access to primary care,” Rural Health West’s, deputy CEO and general manager workforce, Kelli Porter, told Medical Forum.

A committee is set to investigate if and how Medicare changes have affected access to primary care in rural, regional and remote areas.

The inquiry’s terms of reference outline that the probe will consider changes, with particular reference to those that came in as of November.

Headlining a raft of reforms was the 12.5% incentive payment made available to GP clinics that bulk bill all consults, with bulk billing incentive scaled according to remoteness using the Modified Monash Model.

Health Minister Mark Butler has said an additional 1300 general practices have moved to a 100% bulk billing model since the introduction of the incentive.

Ms Porter said there had been “very limited” reports of rural practices moving to universal bulk billing, with most continuing to operate mixed or private billing models.

“Early feedback aligns with what we would expect given the underlying economics in small and remote communities.”

She said many independently owned rural practices were operating in areas of low sustainability, serving small, dispersed populations, facing high fixed operating costs, within limited economies of scale.

“In those settings, Medicare billings alone don’t generate enough revenue to meet the threshold of financial viability, regardless of the incentives on offer,” Ms Porter said.

“As a result, in some country locations, local governments are increasingly stepping in with significant financial and in-kind support – things like housing, vehicles, practice facilities and locum subsidies – often because the alternative is losing the GP in their community altogether,” she said.

Ms Porter said the growing reliance on local government was not sustainable.

“It points to a deeper structural problem in how primary care is funded in rural Australia,” she said.

“Against that backdrop, the 1 November bulk-billing incentive changes in isolation are unlikely to resolve the core viability challenges facing rural general practice.”

Ms Porter said the incentives did not address the “fundamental mismatch” between Medicare revenue potential and the cost of delivering care in rural and remote areas.

“In many MMM 5-7 locations, practice viability is reliant on non-Medicare incentives and local support, which shows that incremental rebate changes on their own won’t fix entrenched inequities in access,” she said.

Ms Porter, who said her organisation’s submission to the inquiry would recommend “more considered, system-level reform” to improve equity of access for rural communities, also said her organisation had concerns about quality of care.

“We’re also hearing early signals about potential impacts on continuity and quality of care – including pressure towards shorter, high-turnover consultations and more fragmented care for patients with complex or chronic needs,” Ms Porter said.

Rural Doctors Association of Western Australia treasurer Dr Thomas Drake-Brockman echoed some of these points.

Working in Mount Barker across a GP clinic and the town's hospital as a rural generalist registrar, Dr Drake-Brockman sees patients in two different settings.

Rural Doctors Association WA treasurer and rural generalist registrar, Dr Thomas Drake-Brockman.

“What I do notice is if they turn up to the hospital, I can spend a lot more time with them and get paid better for it,” they said.

“The incentive structure is not there to actually manage these people's care in the lowest cost setting possible, which would be primary care.”

Dr Drake-Brockman said while many patients they see, visit the doctor less frequently due to distance and lifestyle factors and may require longer consults - current Medicare rebates incentivised short appointments.

“If you can see a patient in six minutes, you'll have a much more viable business than someone who's seeing patients for 30 minutes or 40 minutes."

The inquiry will also look at whether current Medicare support settings work for the mixed-team models of care required in rural, regional and remote communities.

Dr Drake-Brockman said one of their biggest frustrations as a doctor was they could only bulk bill for the time the patient spent in front of them.

“If they need to spend some time with a nurse to have something gone through in detail or have some preventative activities or these kinds of things, there are very limited circumstances in which that time can be bulk billed," they said.

“The building up a multidisciplinary team in general practice, and allowing all the different people who are working there to work at top of scope, is not currently possible under the MBS settings."

Submissions to the inquiry close of March 27 and the committee is expected to provide its final report by June 30, 2026.