A TikTok-famous doctor has explained why visits to the GP are becoming more expensive for Aussies and how the government’s lack of urgency to increase the Medicare rebate is pitting doctors and patients against each other.
Doctor Michael Mrozinski has been going viral on TikTok for his simple explanations about why out-of-pocket gap fees are rising for a simple visit to the GP.
His comments come after medical groups were quick to condemn the Federal Government’s lack of measures to increase the Medicare rebate as bulk-billing has fallen 3.6 percentage points in the last quarter.
Last month, doctors fired a warning shot declaring Medicare is on “life support” after a decade of funding left GP surgeries with little option but to suspend bulk-billing.
The decline of bulk-billing is leading Aussies to delay their visits to the doctor, see another doctor who does bulk-bill, or stop going altogether.
There are fears the health system is slowly reverting to what it was like before the introduction of Medicare in the 1980s, with people unable to access care if they can’t afford it.
For the common Australian, it may be confusing or worrying as to why their doctor has suddenly asked for a fee, but Dr Mrozinski has answered all the hot-topic questions.
WHAT TYPES OF GP PRACTICES ARE IN AUSTRALIA?
There are three different types of GP practices in Australia, including a fully privatised practise where they always charge a fee no matter the situation.
“If you’re under 16, if you’re over 65 or if you’re any other age you would pay a fee and then you would get a rebate from Medicare,” Dr Mrozinski told NCA NewsWire.
“For example, if you go to see a GP and then after your consultation you would tap your card on the machine on the way out for $80, but you get a rebate for $39.
“Medicare or the government will basically pay $39 towards your GP appointment.”
He said it was easy for people to get confused between bulk-billing GPs and completely private practices.
Patients don’t “have to go and see a private GP”, but the service is there for people who want to pay for the service, the doctor explained.
Dr Mrozinski, a Melbourne-based doctor, said nothing has changed for private practices other than prices increasing in recent years as a result of inflation.
The second type of GPs in Australia are called a “mixed billing practice”.
“These are GP practices which will bulk-bill if you’re young or over 65 and have a pension card,” Dr Mrozinski said.
“They’re happy to just take the Medicare rebate from the government and not charge any extra on top of that, but everybody else would pay.”
Finally, there are fully bulk-billed clinics, where doctors usually just take the rebate from Medicare and not charge a fee on top.
Bulk-billing clinics have been around since the beginning of Medicare, when the rebate was just $20.
HOW MANY PATIENTS CAN BULK-BILLING GPS SEE?
In order to keep up costs while not charging any extra fees, Dr Mrozinski said most doctors attempt to book four consults per hour.
“I have worked with some GPs who would try to see six patients, and at that rate and that level, back when Medicare started, $20 was enough to cover all the costs,” he explained.
GP clinics are not funded by the government, meaning the rebate of each patients needs to cover all overheads including rent, staff, insurance, electricity, internet, IT and machinery.
“Back in the day, when the Medicare rebate was $20 in 1985, that covered all the costs, all the wages and that’s why you could go and see a doctor without having to pay anything on top,” Dr Mrozinski said.
“That’s been the way for quite a number of years until 2013 when they started to freeze the Medicare rebate.”
WHAT SHOULD THE MEDICARE REBATE BE NOW?
According to Dr Mrozinski, the Medicare rebate should be about $60 now.
Meanwhile, the Australian Medical Association estimates the rate should be closer to $80.
“Somewhere between $60 and $80 is where they think that with inflation indexing and all that over all those years, a 15 minute consult with a GP should have a rebate of between $60 to $80,” he said.
But the government has only lifted it to $39.
While many people think paying a fee at the doctor means they’re going to be out of pocket, Dr Mrozinski is ensuring them they will get more than half of it back with the rebate.
“When you actually see what goes into running a practice and all the overheads, compared to what you’re getting, it’s just like any other business, you have to have enough to cover all those things or else the practice can’t run,” he said.
HOW DOES THIS AFFECT BULK-BILLING PRACTICES?
If a doctor is seeing four people an hour, the Medicare rebate they would be receiving would equate to $156 per hour.
But all that money isn’t going straight into their pockets.
“People think that $160 goes to the doctor but the doctor would get about 65 per cent of that number,” Dr Mrozinski said.
“The rest of it would go to paying the staffing and all the overheads.”
To sustain a bulk-billing model, doctors have to do “as much as they can” in a short space of time, which often leads patients feeling like they’ve been skimmed over or rushed.
Generally, Dr Mrozinski said people don’t mind paying a little bit extra if they feel like they’re getting a good service.
“It’s when they feel like they’ve been a bit rushed or they feel like the doctor hasn’t really done much,” he said.
Dr Mrozinski explained the rate of inflation has made it difficult to sustain bulk-billing GP practices.
He said the increasing inflation has now “tipped the edge” for doctors as clinics are finding it “incredibly difficult” to cover their costs based only on the Medicare rebate.
As a result, bulk-billing clinics are having to ask customers to pay an extra $10-20 on top.
“What’s really important to me is that people get access to medical care without having to pay, so it’s important that these clinics are kept going,” Dr Mrozinski said.
WHO IS AT FAULT?
While no-one in particular can be blamed for the rising cost of inflation, Dr Mrozinski said the government should be held responsible to lift the rebate.
Otherwise, tensions could get worse.
“The government’s kind of almost pitting patients against medical practices and doctors by not indexing the rebate to help GP clinics cover the cost,” he said.
“It’s come to a point where it’s not sustainable for the clinics to keep bulk-billing and I think it’s a shame that it’s coming to a point where we’re having to ask patients to top that up.”
As long as inflation keeps going up and the government refuses to raise the Medicare rebates, the amount of access to bulk-billed clinics is expected to “really dry up”.
Whether a person can have access to adequate medical care will depend on the amount they can spend, if things continue to get worse.
Dr Mrozinski said it should be up to the government to have the conversations with doctors as he doesn’t agree with clinics having to bump up their prices.
“Right now the only option for these clinics is to pass the gap onto patients, but I absolutely see the frustration from people,” he said.
“Especially if you’ve got a chronic medical condition and you go to see your GP quite often.”
While some GPs still offer discretion and can help someone who is in financial hardship, Dr Mrozinski say it’s a hard spot to be in.
“I would still quite happily bulk-bill, but it’s just not sustainable to do that for everybody, the clinics will end up folding and not be able to run and that’s just the honest truth,” he said.
“I know if I’ve got patients who are in a hard spot, I will still bulk-bill them.”
WHAT ARE PATIENTS DOING?
While doctors are being transparent about charging a fee, Dr Mrozinski said some patients can be understanding but others will take their business elsewhere.
In a bid to pay less, patients are moving doctors or even halting their visits to clinics altogether.
Dr Mrozinski said this is detrimental as it is critical for people see a doctor regularly, otherwise their care can be “fragmented”.
“If you went to see a doctor in one part of the town and they did all this work on you, they did all these investigations and then you went to another doctor and they had no idea what the other doctor had done,” he said.
“You’re just going to go round in circles. You’re not going to get very good care, I think.”
In his experience, patients are willing to travel from 45 minutes to one hour away from their home in order to go to a bulk-billed clinic.
“I really hope it hasn’t stopped people from going to see the GP,” Dr Mrozinski said.
The attitude around medical care is such a new conversation, he said it’s hard to tell if it is having an affect on health outcomes.
Health practitioners will be able to see whether it is having an impact over the next six-months to a year.
In a bid to help the situation, the government has introduced urgent care centres, where people can talk to an emergency doctor if they can’t get an appointment with a doctor.
“I think the government is kind of looking at other options to try and fill the gap left by bulk-billing doctors, but they’re still very important so the people who don’t have the financial means can still get care,” Dr Mrozinski said.
WHAT ARE DOCTORS SEEING FIRST-HAND?
While frustrations can be heard far and wide from patients, Dr Mrozinski said it’s also being felt on the other side of the desk.
“We as doctors are just as frustrated as patients are,” he admitted.
“It’s not a conversation we like.”
Mr Mrozinski said he himself feels really uncomfortable when he has to ask people about money.
He again emphasised that patients and doctors are being “played off” against each other by the government.
“Somebody has had to make the decision and doctor’s decided to charge a small fee and it’s a shame it’s gotten to that point,” he said.
Dr Mrozinski said “many people out there” will put off going to see a doctor until they feel like there’s no other option.
People will put up with symptoms for a “lot longer” than they would have normally, as a result.
“It worries me because when people put these things off, by the time they come to see us it could have turned into something a lot more serious,” the doctor said.
“It’s just not a good situation for anybody.”
WHERE TO FROM HERE?
Dr Mrozinski is happy to be opening up the discussions on TikTok and beyond with younger generations.
He also hopes the Labor government is a “lot more keen” to talk about the future of health care.
“Hopefully we can come up with a long-term plan as to how we can keep general practice going,” the doctor said.
“Once we start talking about it and getting everything out in the open, I think that’s how we can make some changes.”
As overheads have continuously become more expensive, Dr Mrozinski said the move to stop bulk-billing is inevitable.
Unless the Medicare rebate goes up, it was “always going to be on the cards” that patients would need to supplement the rebate.
“This is the reason why we’ll have to put an extra fee, because we can’t keep the practices open,” Dr Mrozinski said.