Half of Australians charged out-of-pocket fees for Medicare services   

16 August 2018
Sydney Morning Herald


Patients in North Sydney are charged the biggest out-of-pocket fees in the country for Medicare services including GP and specialist consults, diagnostic imaging and obstetrics, national data reveals.

Half of Australians paid a gap for non-hospital Medicare services in 2016-17, found an Australian Institute of Health and Welfare analysis released on Thursday.


The report comes the same day Health Minister Greg Hunt released Medicare data showing record high bulk-billing rates of 86.1 per cent for 2017-18, a 0.4 per cent increase on the previous year.

“A record amount of Australians are visiting their doctor without having to pay a cent,” Mr Hunt said.

More than 133 million GP services were bulk-billed in 2017-18, up 5.7 million from 2016-17, according to the Medicare data. In NSW, 88.9 per cent of GP services were bulk-billed.


GPs and public health advocates called the data misleading, saying the AIHW report exposes the true burden of out-of-pocket costs for Medicare services.

The figures represented the number of services bulk-billed, not the number of patients GPs treat, medicos say.

Almost 11 million Australians paid some gap for non-hospital Medicare services in 2016-17, according to the AIHW report.

The data "shines a light on just how misleading bulk-billing figures can be", Australian Healthcare and Hospitals Association chief executive Alison Verhoeven said.   

More than one in three patients who had a Medicare-subsidised GP visit paid a gap in 2016-17, according to the report.


The average out-of-pocket costs ranged from $12 in Western Sydney to $32 in the ACT.

President of the Royal Australian College of GPs Harry Nespolon said just 29 per cent of GPs bulk-billed all their patients. These patients were most commonly children, the elderly and patients who could not afford to pay.

"It’s not surprising that these are the patients most likely to visit their GP with more complex conditions", Dr Nespolon said.

Across all non-hospital Medicare services, the average gap among patients who had some out-of-pocket fee was $142, according to the AIHW.

Roughly 1.1 million people paid at least $601 out-of-pocket for these services in 2016-17.

There were wide disparities in the amount patients paid depending on where they lived.

Patients in Northern Sydney forked out an average of $206 for Medicare services; the highest in the country and almost double that of Western Queensland ($104).

Northern Sydney also had the second-highest proportion of patients who paid a gap (62 per cent). In the ACT, over two-thirds of patients (69 per cent) paid a gap.

The 10 per cent of patients with the highest costs in Northern Sydney paid at least $876 out-of-pocket each over the year.   

Overall, patients spent $3 billion on out-of-pocket costs in 2016, of which 34 per cent went to specialists, 25 per cent to GPs, 12 per cent to diagnostic imaging and 6.6 per cent to obstetrics.

The out-of-pocket costs were “especially grim” for patients referred to specialists, Ms Verhoeven said.

More than seven in 10 people who saw a specialist paid some out-of-pocket cost, with the median gap at $64. Across PHNs, that median gap ranged from $36 to $97.

In Northern Sydney, 83 per cent of specialist patients paid a gap (median $87).

Ms Verhoeven said the fees patients were being charged "had little to do with the ideals of a universal healthcare system, and everything to do with supply, demand and what the local market will bear".

City-dwellers were less likely to have out-of-pocket costs than patients in regional areas and their out-of-pockets costs were lower on average ($155 versus $122 respectively).


Health Minister Greg Hunt said the expert committee headed by the chief medical officer would investigate out-of-pocket costs.


In January, the federal Health Minister directed Australia’s Chief Medical Officer Brendan Murphy to head up an expert committee to investigate high out-of-pocket fees and bill shock.

"We want strong action, built around fee transparency, ensuring consumers know exactly what the cost of a service is well before they commit to it," Mr Hunt said.

"And I guarantee that we will continue to put more funding into Medicare through new items and greater support for doctors, building on our record funding.

whiteknight wrote on Aug 16^th, 2018 at 6:43am:


How much would you pay to stay alive? The cost of a packet of fags? Maybe forgo a night out on the turps?

salad in wrote on Aug 16^th, 2018 at 11:07pm:


A night out on the turps might be better than medical treatment these days ....

Do these over-charging doctors guarantee you will stay alive?  Or are they just rolling the dice?

Valkie wrote on Aug 17^th, 2018 at 6:23am:


You forgot psychiatrists, the medical specialists Valkie most needs.

I have been to see a doctor once in the last 10 years covered by Workers comp not medicare.

If i add up what the Medicare levy costs me at tax time I have been subsidising everyone else for the last couple of decades.

User pay nonsense.  Public good needs to be funded by everyone, not just the user.

House burning down is the only time you pay for fire services?  Only when you need the police do you pay them for services?

stunspore wrote on Aug 18^th, 2018 at 5:14pm:


You just might have a point if everyone paid the same amount of tax?

The whinging majority pay just about effall for those services. 

The cost is stolen from an enslaved minority by the ochlocratic majority.

stunspore wrote on Aug 19^th, 2018 at 9:28am:


...those that pay the majority of tax obviously

stunspore wrote on Aug 19^th, 2018 at 9:28am:


.....so you agree that the user should be paying?