I remember the first time I went to see the doctor on my own. I was a teenager and felt much more independent than I really was. After the consult I walked to reception and froze; I know that sometimes mum paid, but I remember sometimes just walking out… When the woman on the counter told me the consult was bulk-billed, I awkwardly handed money over. She clarified that it was free, so I fumbled my change into my pocket and left. How could it be free? Bulk what?

If you’ve ever found yourself asking what is bulk billing or what are gap payments then you are not alone; this is a question I get asked frequently at work. I believe that not enough Australians understand our healthcare system, or how fragile it is. Unfortunately this means we are at risk of losing it. Losing universal (or free) healthcare would be detrimental to Australia’s overall health, so let’s try to get a basic understanding of our healthcare system.


What is Bulk Billing?

Put simply bulk-billing is when your doctor (or other practitioner, like psychologist or physiotherapist) accepts what the government is willing to pay for that service and charges us nothing. There’s a list called the Medicare Benefits Schedule that describes every medical service that will either be fully or partially paid for by the government and how often we are entitled to that service. For example for a standard visit with your doctor the government pays about $37. If your doctor accepts that and doesn’t charge you anything, that’s called bulk-billing. Certain items, like visits to the doctor, we have unlimited access to, however others we don't, for example for psychology visits we are only entitled to 10 Medicare rebates per year. 

What are Gap Payments?

If you have to pay for your doctor’s visit, or for your psychologist etc., this is known as charging a gap payment. Let’s say the Medicare consult is $37, that’s what the government is willing to pay, but your doctor charges $60. You will be $23 out of pocket - you’ve had to pay the gap. This is the same for all other services, for instance specialist and allied health appointments. 

We are seeing an increase in gap payments. The predominate reason for this is that the standard amount the government pays practitioners has not increased in years and the government wants to continue this freeze until at least 2020. However as everything else is getting more expensive due to inflation, doctors are forced to start charging a gap to accommodate for increased expenses. 

Why do I need to know this?

For most of us free healthcare is all we’ve known and we don’t appreciate how much it’s benefitted our health nor how much would change if we lost it. While I do think the government should spend more on public healthcare we are partly responsible for costs going up. 

In Australia the rates of preventable chronic diseases like obesity, heart disease and Type II diabetes is increasing rapidly. This puts huge pressure on the public health system to accommodate for the increase of patients and services required. This is especially true for hospital visits, in which not only service but staffing costs must be considered.

As these costs increase, we see cuts to healthcare in other sectors like community mental health, staffing for hospitals or increasing gap payments. If this trend continues I predict the government will argue that the only way to manage these costs is to privatise our healthcare, meaning we will be charged for every medical service required. Already there are plans to attempt to privatise pathology; this means people may have to pay for blood tests, basic scans, or even pap smears. Historically we know that this will stop people getting regularly tested and destroy preventative healthcare. This means more sick people and even higher costs! Those who will suffer most are people in lower socio-economic brackets who can’t afford it, and people with chronic illness who need regular repeat testing. 

What can we do?

Our part in this is to become actively involved in our healthcare! We can get on top of issues like obesity and Type II Diabetes by regularly attending the GP for check-ups and working with them on a healthier lifestyle. If the rates of these diseases go down, costs go down. Don’t get me wrong I am lucky to work with some really inspirational patients who tackle their issues head-on but I see the other side. A lot of Australians view free healthcare as a right rather than a privilege. They will happily abuse their health but continue to expect free services. It must be a system of mutual respect in order to maintain bulk-billing. 

If we make these healthier changes I’m optimistic the government will stop punishing the public health system with cost-cutting measures and invest into our healthier Australia. Universal healthcare is amazing and sets a nation apart in terms of care for its citizens, let’s not lose that.


A last important point to note; it’s true that Medicare is only theoretically free and we pay in part from our taxes. When you look at how the Medicare levy is deducted from our income tax however, we can see that it doesn’t end up being that much that we are paying compared to the benefits we can reap. 

Every year when we pay tax we are charged a ‘Medicare Levy’ which is about 2% of our yearly taxable income (less if you’re a low-income owner or fall under a support category, and more if you’re a high-income earner, especially without private health insurance). On average this is about $1500 per person every year. This may sound like a lot but health technology is expensive and with the rise of chronic disease our public healthcare system is under immense pressure. For example getting admitted overnight in hospital, especially if you need any scans or blood tests, might already be $1500 in services the government is paying. That is for just one night’s care! Add on the wages of the staff involved in your care, follow-up doctor’s appointments, non-related scans and blood tests you might have had and you can see how it isn’t really that much we have to pay through tax. 

I hope learning about our healthcare system has inspired you to become involved in your own healthcare, and more importantly to spread this message and inspire others. We are lucky to have first world care without bearing the financial burden of what it’s worth and it comes with the responsibility of taking care of ourselves. Or, “There is no (free) healthcare without self-care!.” 

Resources/ Suggested Reading: 

DOHS, 2016, ‘Medicare Services’, Department of Human Services, Canberra, viewed 15 October 2016, < https://www.humanservices.gov.au/customer/subjects/medicare-services>.

DOH, 2016, ‘MBS Online’, Department of Human Services, Canberra, viewed 15 October 2016, < http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Home>.  

Article: ‘Ley says cuts may leave patients worse off’, The Australian, Dec 17 2015, access October 15 2016, < http://www.theaustralian.com.au/news/latest-news/shorten-rejects-medicare-changes/news-story/f71921dfe52f4ffefbbb80d441350019>. 

Article: ‘Medicare rebate: Doctors' fees to rise after AMA recommends price hike’, ABC News, 19 Oct 2016, accessed 20 October 2016, < http://www.abc.net.au/news/2016-10-19/ama-recommends-doctors-raise-consultation-fee-to-$78/7946028>.