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Factors affecting general practitioner charges and Medicare bulk-billing: results of a survey of Australians

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Data from Medicare Australia show that 76.9% of all Medicare Benefits Schedule (MBS) services were bulk billed (charged directly to the Commonwealth without a patient copayment) in the December quarter of 2013.1 The proportion was 81.9% for general practitioner services.1 These historically high rates of direct-to-government charges have in part led to calls for the introduction of minimum patient copayments for GP services. While much has been written in the media about the potential impact of such copayments, perhaps less is understood about the factors affecting decisions to bulk bill or to charge patient copayments, and how these factors are linked to patient-reported characteristics of general practices.

Studies of bulk-billing have largely focused on GP-specific factors, using data from surveys or large administrative datasets to explore bulk-billing behaviour. Studies of the impact of GP density (number of GPs in a given area) on bulk-billing behaviour have shown that the greater the number of GPs, the greater the propensity to bulk bill.2,3 Some surveys of GPs have specifically explored factors determining bulk-billing. One study identified that among a sample of GPs practising in New South Wales, the odds of bulk-billing were higher for those in major cities compared with those in rural…