Changes in cost of general practice services following bulk-billing incentive payment reform in Australia: An interrupted time-series analysis — The Association Specialists
  1. Schedule
  2. Oral Presentations - Conversations starters - population health & wellbeing
  3. Changes in cost of general practice services following bulk-billing incentive payment reform in Australia: An interrupted time-series analysis

Changes in cost of general practice services following bulk-billing incentive payment reform in Australia: An interrupted time-series analysis (23843)

Jennifer Welsh 1 , Karinna Saxby 2 , Yuting Zhang 2 , Rosemary J Korda 1
  1. National Centre for Epidemiology and Population Health , Australian National University, Canberra, ACT, Australia
  2. Melbourne Institute: Applied Economic & Social Research , University of Melbourne, Melbourne , Victoria , Australia

Background: To promote equitable access to affordable primary health care, General Practitioners can claim an incentive payment from Medicare for each service provided to eligible patients that incurs no out-of-pocket cost (OOPC, known as ‘bulk-billing’). From November 2023, the value of the incentive was tripled but the extent to which this reform supported affordable care is unclear, including whether there were unintended consequences for patient populations not directly targeted by the reform. We quantified changes in key cost metrics within general practice associated with the triple bulk-billing incentive reform.

Methods: Using whole-of-population data from Medicare and Centrelink (1Jan2021-31Dec2024), we conducted interrupted time-series analyses to quantify monthly changes in proportion of GP services bulk-billed and per-service out-of-pocket costs (OOPC) for non-bulk-billed services associated with the triple bulk-billing incentive reform after accounting for seasonal trends. We quantified changes for the total population and separately for patient populations who were (children <16years, Commonwealth concession card holders) and were not (general beneficiaries) eligible for incentives.

Results: In the 12-months prior to the reform, bulk-billing was generally high, and was higher among children and concessions compared to general beneficiaries, but declined among all patient populations. The reform was associated with a step-change increase in bulk-billing of around four percentage points (4.48, 95%CI: 3.12, 5.83) and appeared to arrest declines, including among general beneficiaries (post-intervention slope:-0.04, 95%CI:-0.13, 0.06). However, the reform was also associated with an immediate increase in OOPC ($2.71 95%CI:1.57, 3.85), particularly among children ($4.46, 95%CI:2.86, 6.06) and concessions ($6.13, 95%CI:2.99, 9.28), followed by sustained monthly increases in these costs ($0.23 per month, 95%CI:0.12, 0.34).

Conclusion: The triple bulk-billing incentive reform was associated with positive and negative changes in affordability that extended beyond the patient populations directly targeted by the policy, with potential to undermine equity in affordable care in the longer term.