What looking at the Modified Monash Model tells us about bulk billing incentives

New data indicates what GPs have consistently said: bulk billing rates increase where funding better reflects the true cost of care, not where there is greater competition between practices.

A recent report from healthcare directory Cleanbill broke down bulk billing and gap fees by how rural a practice was located, based on Modified Monash Model (MM1–7) classification.

It shows that the largest increases in 100% bulk billing have occurred in regional and rural areas where government incentives were highest, yet where health department data show there are fewer GPs per person.

The Cleanbill report showed the share of practices bulk billing all patients rose more in MM 2–7 regions than in metropolitan areas. It also showed average out of pocket costs have risen by 13.5% for patients paying a gap, with higher costs persisting outside capital cities.

RACGP President Dr Michael Wright said this demonstrated that intervening in the market did not deliver fair pricing or access, but adequate funding does.

A previous report by Cleanbill showed higher proportions of bulk billing clinics alongside higher average out-of-pocket costs across the country since the introduction of the federal government's  incentive program.

“But the extent of these trends differed markedly state-to-state; highly urbanised states like Western Australia saw more muted bulk billing and out-of-pocket increases than less urbanised states like Tasmania,” CleanBill’s follow up report stated.

“We suspected this variance was due to regional clinics switching to bulk billing at higher rates than their metropolitan counterparts.”

CleanBill analysed historic trends in bulk billing and out-of-pocket costs across each MM area to provide region-based insights into the impacts of the Medicare changes.

Dr Wright said the findings validated the College’s call for an independent Medicare pricing body and a 40% increase in rebates for longer consultations.

“This report shows exactly what we said would happen has happened. When funding better matches the cost of care, bulk billing increases," Dr Wright said.

"This shows why our patients need the funding for their care to be set by an independent pricing authority which can ensure Medicare funding matches the cost of their care, particularly in areas where costs are higher or the GP workforce is more stretched.

“The current federal government’s investments show the value it places on primary healthcare, but this doesn’t guarantee the same level of commitment from future governments.

“An independent pricing authority would provide transparent, evidence-based decision making that directs funding where it’s most effective and most needed. This would give GPs the trust and certainty they need when they make financial decisions, including about billing policies.”

He said this was not about competition between GP clinics, it was about Medicare funding covering the cost of providing care.

The RACGP warned of a growing two tier system, with regional Australians more likely to face higher gaps when bulk billing was unavailable, despite having fewer local GP services.

“In most states, fewer than 35% of GP clinics are located outside capital cities,” Dr Wright said.

“This workforce maldistribution, combined with inadequate Medicare rebates, makes access harder for patients who already face the greatest barriers.”

Dr Wright said incentives may “shift behaviour in narrow ways” but did not fix the system.

The report was released as Health Minister Mark Butler celebrated a milestone in his push towards having 90% of GP clinics to be fully bulk billing by 2030.

More than 3,700 Medicare bulk billing practices were now registered across the country, exceeding government projections that 3,600 practices would be achieved by late 2027, according to government figures   Of the over 3,700 practices now registered, 1,400 were previously mixed billing practices.

In WA a total of 227 clinics were now 100% bulk billing, almost double the amount prior to the incentive program launching.