One year on - are bulk billing incentives working?

The number of practices fully bulk billing patients has almost doubled in the last year, according to data released by the federal government on the anniversary of its Bulk Billing Incentive Program (BBIP).

In WA, the proportion of bulk billing clinics now sits at 32% up from 15% before the incentive program began, but RACGP WA Deputy Chair Dr Julia Rawlinson has raised questions about the financial viability of maintaining this rate.

WA's bulk billing numbers remain relatively unchanged since the last round of data was released in August, which also showed the total number of clinics signed up to the program was 235 – about one third, taking the bulk billing rate to around 76%.

The state's bulk billing rate had been 69.9% in September 2025, ahead of the introduction of the incentive program.

The number of bulk billing practices in WA has more than doubled since the start of the BBIP, alongside South Australia, Tasmania and the ACT, according to the federal government's data.

Nationally, some 4000 clinics are now fully bulk billing practices. The biggest jump has been in rural areas, where the percentage of bulk billing practices has lifted by 27% to 59%.

The future viability of bulk billing

While Federal Health Minister Mark Butler said increased participation in the BBIP showed bulk billing was now an "attractive option" for doctors and practice managers, Dr Rawlinson said the government had been "pushing practices to bulk bill," which suits their political agenda.

"On one hand, they're telling us that they're all for universal bulk billing," she said, but pointed to a 4.41% increase to private health insurance premiums and a failure to keep Medicare rebates in line with CPI.

"What that says to me is, 'We will charge you more for your private health insurance, and we will rebate you less as a patient to cover your healthcare costs'."

While CPI rose 4.2% in the year to July 1, Medicare rebates were increased by just 2.6% when indexed as of July 1.

Dr Rawlinson said given the latest Medicare Benefits Schedule (MBS) indexation was a fair amount below CPI, some of the clinics that signed up to the incentive program may be faced with having to rethink whether it makes financial sense to continue fully bulk billing.

“When all these practices became fully bulk billing and took on this government challenge I'm sure many of them would have hoped that that Medicare rebates would rise in line with CPI," Dr Rawlinson said.

“Many GP practices run as a small business and you're asking us continually to do more with less. It just makes practice non-viable, you can't cover the cost of providing care if that rebate doesn't continue to increase.”

Bulk billing's fast patient turnover

Dr Rawlinson also raised concerns that the focus on bulk billing alone encouraged faster turnaround of patients.

“With bulk billing practices, the more patients you can see the more that you can bill, and the higher per dollar value per minute for that shorter consult. So it does reward shorter, faster clinical medicine.

“We are disadvantaging our patients with more chronic and complex diseases because then that patient has to come back for a number of short appointments to rebate a higher amount, rather than just being able to see their GP and deal with a number of chronic complex conditions in one go."

She said the RACGP continued to call on the federal government for a 40% increase to the rebates for longer consults.

Unmet targets

However, despite the $7.9 billion investment to expand access to bulk billed GP appointments, the government has failed to meet its own targets for patient access to Medicare subsidised services.

According to the Department of Health, Disability and Ageing’s annual report just 87.8% of patients accessed MBS services in 2025/26, down from 88% in 2024/25 and 88.6% in 2023/24. The department had set a target of 90%.

It noted a sharp decline in bulk billing rates from 2022/23 but reported since the introduction of the BBIP rates had started to recover.

“Although the performance target was not achieved, government measures introduced to improve access to bulk billing supported the 2025/26 result,” the report said.

"These initiatives contributed to increased bulk billing rates following a decline during 2022/23 and early 2023/24. As bulk billed services do not incur out-of-pocket costs for patients, increasing bulk billing rates may improve affordability and support greater access to MBS services over time.”

The department also failed to meet its target for the number of patients accessing Medicare-subsidised non-referred GP appointments.

A target of 85% or more was set but the actual number of patients who had a GP non-referred appointment came in at 83.6%, down from 83.8% in 2024/24.

The department noted a number of factors that could have contributed to the decline, including rising out-of-pocket costs, use of non-MBS privately funded services and pharmacy prescribing pilots which allow patients to access care through other services.

Earlier this year, the Department of Health lowered its own performance target on the number of Australians to take part in Medicare covered GP visits for 2026/27.

It quietly reduced the target from 85% to 80% to reflect an expected reduction in demand as patients access care through other channels.