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Cutting down on the bulk

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The Federal Government has refused to rule out suggestions it is planning to limit access to bulk billing as part of a system of tiered GP rebates.

The Australian Financial Review has obtained details of a Department of Health plan under which Medicare rebates for GP services would be paid according to a three-tiered scale.

General practitioners would receive the highest rebate (sufficient to support bulk billing) for treating children and concession card holders; would get a lesser amount for seeing patients who eligible for Family Tax Benefit A; and would receive the lowest rebate for treating all other patients.

According to the AFR report, the Department estimated the reform, which was rejected by the former Labor Government, would save $860 million over five years.

A spokesman for Health Minister Peter Dutton declined to comment on the proposal, but the Minister has said Medicare needs to change in the face of spiralling costs.

In a major speech last month, Mr Dutton indicated he was considering a system of “blended” payments for GPs, including an annual fee for each patient rather than the purely fee-for-service model of remuneration used now.

The Health Minister has also expressed concerns about taxpayer-subsidised access to GPs for all patients, regardless of income or assets, expressing the view that it was not unreasonable for the better off to make a greater contribution to the cost of their care.

But AMA Council of General Practice Chair Dr Brian Morton warned many doctors were likely to walk away from bulk billing altogether if the Government adopted the plan.

Dr Morton said the discretion of whether to bulk bill or not should be left with GPs, who were best able to act in the interests of their patients.

A Fairfax Media/Nielsen Poll conducted before revelations of the Health Department plan found any move to means test access to bulk billing for GP services could be divisive.

The poll found that while 52 per cent were receptive to such a move, 46 per cent were opposed – with Coalition voters (55 per cent) the most supportive of the idea.

Adrian Rollins