Monique Ryan (Kooyong, Independent) | Hansard source

I thank the member for Reid for moving this motion. I'm happy to acknowledge that bulk-billing rates increased in every state and territory in the last quarter. The Bulk Billing Practice Incentive Program is having a measurable effect, and the government deserves credit for that.

However, for the GPs and the patients of Kooyong, the experience of Medicare in 2026 is much more complicated than the headline figures suggest. In south-eastern Melbourne, the bulk-billing rate is essentially static—it's just over 74 per cent—and for those patients who attend practices that aren't able to bulk-bill, the average out-of-pocket costs increased by 9.4 per cent in the last 12 months. It is now $93.44. According to Cleanbill, 147 electorates out of the 150 in this country have experienced an increase in out-of-pocket costs on average to see a GP in the last year.

The Medicare Benefits Schedule was built around short, episodic consultations, but that model no longer reflects the reality of general practice. More than half of all Australians have at least one chronic condition, and a growing number have two or more. Managing complex multimorbidities takes time, but GPs who do that are financially penalised for doing so. Recently, the Grattan Institute found that GPs are paid as much as $15.41 per minute for a two-minute bulk-billed consultation, as opposed to $3.30 a minute for consultations for more complex issues that take as long as 20 minutes. That's not a sustainable model when we have an ageing population with increasing rates of chronic illness.

The government continues to fail to overhaul how Medicare rebates are designed, and the rebates are not keeping up. The Medicare rebate was indexed by 2.6 per cent this year. That's against general inflation and wage growth much higher than that. Every year that the rebate is indexed below the annual cost of running a practice—lower than wages, rent, compliance and insurance—that's a year in which the gap between what it costs to deliver a bulk-billed service and what Medicare pays for it widens further.

A recent Consumers Health Forum survey gives us a really clear idea of the current patient experience in Australia. Almost half of all respondents, 49.8 per cent, said that they had missed health care that they needed in the last year, and the leading reason for that was cost. Two in three, 67 per cent, of those who skipped dental care said that they just couldn't afford it. More than half, 54 per cent, of those who failed to fill a prescription said the same. Only one in three Australians felt confident that they could afford medical care if they became seriously ill. When even the most transparent, most accessible part of our healthcare system is generating that level of cost anxiety, it tells us something about the pressure that the whole system is under—cost pressures on patients who need care and cost pressures on practices to maintain bulk-billing.

Finally, I want to acknowledge the changes to assignment-of-benefit requirements announced by the government late last week. Prior to that change, bulk-billing in many practices, community health centres and aged-care facilities was under immediate threat. For patients who can't easily engage with a digital consent workflow—children, people in mental health crises, people with intellectual disability, elderly patients who don't have a smartphone, people from non-English-speaking backgrounds, aged-care residents—a failed consent capture means that either their bulk-billed service goes unpaid or it's converted to a private bill.

I wrote to the minister several times, raising urgent concerns about this proposal. The last-minute extension of the current arrangements, which came at the end of last week, was after sustained pressure from the RACGP, the AMA and other expert groups. In response to that advocacy, I'm glad to see the government extend verbal assignment of benefits until July 2027. Without that change, our bulk-billing system would have been under immediate administrative threat.

Bulk-billing increases are real in some parts of this country, and they're certainly welcome. But Medicare's long-term health depends on rebates keeping pace with the actual cost and complexity of care, and on the administrative architecture supporting access, not undermining it. I ask the government to turn its attention to both of those things.

See this speech in context