Rising Out-of-Pocket Costs for GP Appointments
A recent report from Cleanbill, an online directory of general practitioners (GPs), has revealed that Australian patients at clinics that do not fully bulk-bill are paying 13.5 per cent more to see a GP than in the past. The April Blue Report, which is based on data from 6,900 clinics listed on Cleanbill, indicates that the average cost of a standard consultation now stands at $49.23 out of pocket.
The report also highlights a growing trend where regional clinics are more likely to adopt full bulk-billing models compared to those in metropolitan areas. This shift reflects broader changes in healthcare accessibility and affordability across different parts of the country.
A Personal Struggle with Healthcare Costs
Public servant Matthew Lillywhite shared his experience of navigating the healthcare system. He used to travel from his home in the Australian Capital Territory (ACT) to Melbourne to see his family GP because it was easier than visiting his local doctor in Canberra. At his Canberra clinic, a standard consultation costs $140 upfront, including a $40 Medicare rebate. This price had increased by $40 since he moved to the capital in 2023.
Mr. Lillywhite lives with chronic health conditions that require regular monitoring and prescriptions. To manage the high costs, he relied on a flight attendant friend who arranged $80 return tickets to Melbourne. Although he no longer has access to these discounted flights, he described how this arrangement helped him cope with his medical needs over the years.
“Canberra doesn’t feel like it has universal health care anymore,” he said. While his salary has increased significantly, reducing the percentage of his income spent on GP sessions, he now helps pay for classmates’ medical costs when they cannot find a bulk-billing clinician. Other times, he drives them to appointments they would otherwise struggle to attend due to distance.
“If you can’t afford to pay up front, your options shrink really quickly,” he added.
Regional vs. Metropolitan Trends
The Blue Report categorizes clinics using the Modified Monash (MM) system, a federal government framework that ranks locations from major cities (MM1) to very remote communities (MM7). According to the report, people in very remote areas who are not bulk-billed face the highest out-of-pocket costs, averaging $56.54 per appointment in 2026, up from $50.50 in 2025.
In metropolitan areas, the average cost for non-bulk-billed consultations rose to $48.89, an increase of 14.3 per cent from $42.79 in 2025. Medium rural towns saw the next highest increase, with costs rising to $50.25 from $44.21.
Although the report did not provide specific data for the ACT, earlier reports indicated that only about one in ten clinics in the region fully bulk-billed. Federal Health Minister Mark Butler challenged the reliability of the Cleanbill data, stating that the analysis could not be considered accurate.
Bulk-Billing Surge in Regional Areas
Despite the controversy, the report showed that regional and remote areas have seen a significant rise in bulk-billing practices. The percentage of clinics fully bulk-billing standard weekday appointments nearly doubled in a year, increasing from about one in five to just over two in five.
Regional centres, large and medium rural towns, and remote communities recorded larger increases in bulk-billing rates compared to metropolitan areas. The percentage increase in metro areas was the lowest, at 16.8 per cent.
The report noted that even the addition of one bulk-billing clinic in small regional or rural areas could result in a significant percentage change. The Federal Department of Health provides an online practice finder that allows patients to search for clinics, including whether they bulk-bill.
Concerns Over a Two-Tier System
Caroline Johnson, a GP and associate professor at the University of Melbourne, expressed concerns that Australia may be moving towards a “two-tier” healthcare system. She warned that this could undermine the universality of Medicare.
“We’re offering bulk-billing to some people and a different type of care for people who can afford an out-of-pocket cost, which isn’t in the spirit of what Medicare was set up to do,” she said.
She emphasized that while the report shows positive trends in bulk-billing, the data should be interpreted cautiously. “Those percentages really just show a trend rather than what’s happening in any particular town.”
The Royal Australian College of General Practitioners (RACGP) supported the findings, noting that bulk-billing increases were most significant in areas where funding better reflected the true cost of care.
Impact on Patients
Zowie Lenard, who recently moved from Townsville to Horsham, experienced a dramatic shift in her healthcare costs. Initially, she paid $100 for a consultation, but after the clinic switched to a full bulk-billing model, her out-of-pocket cost dropped to zero.
“It’s lowered the barrier [to accessing GP care] completely, there is no barrier anymore,” she said.
However, for others, such as occupational therapist Phoebe Nagle, the addition of one bulk-billing clinic was not enough. She described the availability of affordable GP care in Horsham as a “full 180” compared to Geelong, where her previous GP was bulk-billing. For individuals with chronic conditions, the financial burden of non-bulk-billing practices can add up quickly.
