As Medicare rebates for GP consults become a mainstream talking point, here’s how other Australian doctors are setting their prices.
When it comes to bulk billing, how much is enough?
While the latest Department of Health statistics would have you believe that just under 90% of GP services are bulk billed, it’s a different story for other specialists.
Psychiatrists, for instance, only accept the direct Medicare payment as their fee for an initial appointment 22% of the time, according to data from the Medical Costs Finder.
Most patients seen for an initial appointment by a psychiatrist were charged about $405 in total and were typically left about $177 out of pocket after the patient rebate.
The Medical Costs Finder, which has been criticised by consumer groups in the past, was launched in 2019 and provides typical out-of-pocket costs for common inpatient and outpatient services.
Past criticism has focused on the fact that the costs finder is very general, in that it only shows aggregate Medicare information across geographic location rather than the fees of individual specialists.
The site is slowly being overhauled to show more detail, with a version incorporating the specific fees of individual specialists allegedly coming later in the year.
For now, it does show a breakdown of what different specialists charge for the same item number, and what proportion of patients they bulk bill for that item.
Across different specialties, the proportion of patients bulk billed for MBS Item 110, which covers the first appointment with a non-GP specialist for a specific condition, varies from 26% in allergy/immunology to 86% in nuclear medicine.
The Medicare patient rebate for an Item 110 is $132.30, still almost $20 more than a GP Level D consult (MBS Item 44) which last at least 40 minutes in length.
This does not include dermatologists, who would more likely charge Item 104 – which covers consultant physicians – for an initial appointment.
Item 104 only attracts a $75.05 rebate, and patients typically paid $225 up front, or $150 out-of-pocket, to see a dermatologist.
Dermatologists only accepted the $75.05 rebate as full payment 9% of the time, and privately billed for the other 91% of appointments.
As well as bulk billing the lowest proportion of patients for an item 110, allergy/immunology specialists also tend to charge one of the highest median amounts for an Item 110, about $300 up front and $168 after rebate.
On the other end of the billing spectrum, the 14% of patients who attended an initial nuclear medicine consult and weren’t bulk billed paid a median price of $113.
The specialties where patients paid the lowest median amount out of pocket for an Item 110 were geriatric medicine at $78, infectious disease at $80 and nephrology at $88.
Sitting around the middle, cardiologists charge patients about $93 out of pocket, respiratory and sleep physicians charge around $115 out of pocket, and rheumatologists charge roughly $148 out of pocket.
Looking at figures by state, the ACT is the most expensive place in Australia to be sick, with the median out-of-pocket cost for an Item 110 sitting at $146.
On the other hand, patients in the ACT are more likely to be bulk billed than those in WA, where the proportion of patient bulk billed for an Item 110 is just 25%.
SA has the lowest median appointment cost for the item, at $78, while doctors in Tasmania bulk bill the highest proportion of patients, at 55%.
