A Medicare card promises the same thing to everyone who holds one: turn up to a doctor, and the country pays. For a warehouse worker in his mid-thirties on Brisbane's fringe, that promise used to be reliable. His local clinic bulk billed him for nothing when his back gave out, when his toddler needed a check-up, when a cough needed a script. Then, one visit at a time between 2021 and 2023, the same clinic began asking for a card at the front desk — not a Medicare card, a credit card. The receptionist explained, apologetically, that the practice still bulk billed pensioners and children under sixteen. Everyone else now paid $40, $50, sometimes more, and claimed a partial rebate back from Medicare days later. He was neither a pensioner nor a child. He paid, or he waited, or — more often than he liked to admit — he stayed home.
He was not unusual. Between the pandemic's peak and 2023, the share of GP visits billed at no cost to the patient fell nationwide, and the fee charged for the ones that were not bulk billed crept upward year after year. The government elected in 2022 diagnosed the same problem and answered with the largest single increase to the bulk-billing incentive in Medicare's history — then, two years later, an even larger one that extended it to every patient, not just children and concession-card holders. The question this piece sets out to answer is simple to ask and hard to answer honestly: after all that money, has primary care actually become easier to reach — or has a system built on the promise of universal, free treatment quietly split into one tier for patients the government has decided deserve protection, and another for everyone else?
What the government did: two rounds of incentive increases, and a network of new clinics
Bulk billing means a doctor accepts the Medicare Benefits Schedule (MBS) rebate — the government's set payment for a given type of consultation — as full payment, and the patient pays nothing at the counter. When a doctor does not bulk bill, the patient pays the full fee upfront and claims the MBS rebate back from Medicare afterwards, wearing the difference — the "gap" — as an out-of-pocket cost. Bulk billing has never been compulsory. It is a commercial decision each practice makes, visit by visit, based on whether the rebate covers what it costs to run the clinic and pay the doctor.
The government's diagnosis was that the rebate had fallen too far behind the real cost of running a general practice, and that bulk billing was declining as a result. The 2023-24 Budget, handed down in May 2023, responded with a $5.7 billion (approx.) Strengthening Medicare package, the centrepiece of which was a $3.5 billion commitment to triple the bulk-billing incentive — a separate payment GPs receive on top of the standard rebate specifically for bulk billing an eligible patient (Australian Government Department of Health, Disability and Ageing, Budget 2023-24 stakeholder pack and media statements, May 2023). From 1 November 2023, the incentive for a standard consultation rose from $6.85 to $20.65 in metropolitan areas, and from $13.15 to $39.65 in very remote areas, scaled by remoteness in between (RACGP, Fact sheet: bulk billing incentives since 1 November 2023). The government described it, accurately on the numbers, as the largest increase to the bulk-billing incentive in the 40-year history of Medicare. It was not, however, available for every patient. Eligibility was restricted to children under sixteen and holders of a Commonwealth concession card — together around 11.6 million people (approx.), a little under half the population (Department of Health, Disability and Ageing, 2023-24 Budget materials).
Alongside the incentive increase, the government launched MyMedicare, a voluntary scheme under which patients register with a preferred general practice. Registration opened from 1 October 2023 and unlocks longer, better-remunerated telehealth consultations and new funding for managing chronic disease, aiming to formalise an ongoing relationship between patient and practice rather than one-off, anonymous visits (Department of Health, Disability and Ageing, MyMedicare programme information). It was billed as infrastructure for future reform rather than an incentive in its own right, and its practical effect on bulk billing specifically has been secondary to the incentive changes.
The policy framework behind both incentive increases traces back to a Strengthening Medicare Taskforce, a panel of clinicians, health economists and consumer representatives the government convened in 2022, which reported in February 2023 and shaped the diagnosis behind the whole package. Its central recommendation was that Australia's heavy reliance on fee-for-service billing — paying a GP roughly the same rebate regardless of how complex a patient's needs are — encouraged short, high-volume consultations at the expense of the longer appointments needed for patients managing several chronic conditions at once, and that the funding model needed to shift toward blended payments rewarding ongoing management of complex patients, not just billable visits (Strengthening Medicare Taskforce, report, February 2023, approx.). The bulk-billing incentive increases responded to the narrower, faster-moving half of that diagnosis — the price signal attached to a single visit — while MyMedicare and its associated blended-funding trials were meant to respond to the slower, more structural half. Two and a half years on, the visible spending and the visible results sit almost entirely on the price-signal side of that ledger.
The government's second major initiative was Medicare Urgent Care Clinics: bulk-billed, walk-in clinics, open extended hours seven days a week, for conditions that are urgent but not life-threatening — a broken wrist, a deep cut needing stitches, a child with a high fever — aimed at diverting people away from hospital emergency departments and overstretched GP waiting rooms. The first clinics opened progressively from 2023, funded by $358.5 million (approx.) in the 2023-24 Budget to establish an initial network of 87 clinics nationally. By December 2024, roughly eighteen months after the first clinics opened, the government reported one million patient visits across the network (Department of Health, Disability and Ageing, media statements, December 2024, approx.). In the 2025-26 Budget cycle the government committed a further $644 million (approx.) to build 50 additional clinics, aiming to bring four in five Australians within a twenty-minute drive of one.
The most significant recent change came after the 2025 election. Having campaigned on a further, larger Medicare pledge — reported at the time as worth $8.5 billion (approx.) — the government extended the bulk-billing incentive to every patient, not just children and concession-card holders, from 1 November 2025, and introduced a new bonus payment of an extra 12.5 per cent on Medicare rebates for practices that bulk bill all of their patients (Department of Health, Disability and Ageing, "Delivering bulk billing for all Australians," media statement, 2025). Costed at close to $7.9 billion (approx.) over the forward estimates, with an annual cost approaching $2 billion (approx.) once fully in effect, the expansion was explicitly framed as fixing the gap the original 2023 measure had left: a working-age adult without a concession card, previously excluded from the incentive altogether, was now covered on the same basis as everyone else. The government set an explicit target of nine in ten GP visits being bulk billed by 2030.
The strongest case for the policy
The largest bulk-billing investment in Medicare's history, targeted first at the people who needed it most
Put the government's defence at its best, and it holds together on several fronts. First, the scale of the commitment is not spin. Tripling a Medicare incentive payment is a genuinely large move by the standards of a scheme that has existed since 1984, and the government funded it with real, appropriated money rather than a re-announcement of existing spending — $3.5 billion in 2023, followed by a further commitment costed at close to $7.9 billion two years later. Few Commonwealth health measures in recent decades have moved that much money into a single lever of the primary-care system in such a short period.
Second, the sequencing was defensible, not arbitrary. Facing a genuine, documented decline in bulk billing and a limited budget, the government targeted the first and largest incentive increase at children and concession-card holders — patients who, by definition, are on the lowest incomes, have the highest chronic-disease burden, or are too young to have any income at all. That is precisely the population a means-tested safety net is supposed to protect first. When data through 2024 showed the gains were real but incomplete — working-age adults without a concession card were still often paying a gap — the government did not simply declare victory. It came back with a second, larger and genuinely universal expansion, funded again with new money rather than reshuffled existing spending. A policy that identifies its own shortfall and corrects it within two budget cycles is behaving the way good policy is supposed to: responsive to evidence, not locked into its first design.
Third, Urgent Care Clinics answer a different but related problem — not who pays, but where an urgent but non-emergency patient can go when their regular GP is booked out and a hospital emergency department is the only visible alternative. A free, no-appointment-needed clinic that has recorded roughly a million visits in its first eighteen months is not a marginal or symbolic program; it is a genuine new front door into the health system, and every one of those visits is, at minimum, a visit that did not add to an emergency department queue or a fee a patient did not have to find.
The evidence: what the primary record shows about billing rates, costs and the workforce behind them
Three separate bodies of evidence bear on whether the incentive spending has worked: the bulk-billing rate itself, tracked by the Australian Institute of Health and Welfare (AIHW) and the Department of Health's own quarterly Medicare statistics; what patients who are not bulk billed actually pay, tracked by the Royal Australasian College of General Practitioners' (RACGP) annual Health of the Nation survey and the Department's own fee data; and the size and shape of the GP workforce delivering the care, which determines whether a healthier billing rate translates into a genuinely accessible appointment.
A decade-scale round trip: from near 89 per cent, down to 77, and partway back
The bulk-billing rate for GP attendances reached roughly 89 per cent (approx.) in 2020, an artificial peak driven by a temporary, COVID-era doubling of bulk-billing incentive payments between March and September 2020 (AIHW, Medicare bulk billing and out-of-pocket costs of GP attendances over time). As that emergency support wound back and underlying cost pressure on general practice kept building, the rate fell for three straight financial years, from 88.8 per cent in 2021-22 to 77.3 per cent in 2023-24 — a fall of more than eleven percentage points, and the lowest sustained rate the AIHW's dataset had recorded outside the pre-2000s era (AIHW, same report). That fall was well underway, and largely complete, by the time the tripled incentive took effect in November 2023; the 2023-24 financial year straddles the policy change and still recorded the low point, because most of the year's attendances occurred before the new incentive had time to change GPs' billing decisions.
The recovery since has been real but gradual, then sudden. Through the first ten months of calendar 2024, the annual rate sat at around 78 per cent (approx.) — only marginally above the 2023-24 trough, suggesting the first incentive increase, while it slowed the decline, had not yet meaningfully reversed it a year after taking effect (AIHW, same report). The larger movement came after the second, universal expansion took effect on 1 November 2025. Department of Health quarterly statistics for the following quarter show 81.4 per cent (approx.) of GP services bulk billed, up from 77.1 per cent (approx.) in the same quarter a year earlier — described in independent commentary as the largest quarterly jump in bulk billing in roughly two decades outside the pandemic itself (Department of Health, Disability and Ageing, quarterly Medicare statistics; Grattan Institute and The Conversation commentary on the release). The number of practices bulk billing every patient also rose sharply, from roughly 2,300 nationally before the November 2025 changes to more than 3,400 within three months (Department of Health, quarterly statistics, approx.).
What patients who are not bulk billed actually pay
Behind the headline rate sits a second number that matters just as much to a household budget: what a visit costs when it is not free. The RACGP's Health of the Nation survey — an annual survey of more than 3,000 GPs and GPs in training, the only report of its kind — put the average fee for a standard (Level B) GP consultation at $82 (approx.) in 2025, up from $78 (approx.) the year before (RACGP, Health of the Nation, 2024 and 2025 editions). Measured a different way, across every GP attendance including the ones billed at no cost, the Department of Health's own quarterly data recorded an average fee of $51 (approx.) in the December 2025 quarter, up from $48 (approx.) a year earlier, a rise that outpaced general inflation over the same period (Department of Health, quarterly Medicare statistics, approx.). The two figures measure different things — one is the fee among consultations that carry a gap, the other blends in the growing share billed at zero — but both moved the same direction for most of the period this piece covers: up.
The RACGP's survey also tracked a narrower but telling measure of supply: the share of GPs who said their practice could bulk bill every patient. That share fell slightly even after the first incentive increase, from 13 per cent in the 2024 survey to 12 per cent in 2025 (approx.), even as the economy-wide bulk-billing rate was recovering — a reminder that a rising national average can still sit alongside most individual practices continuing to charge most of their patients a gap. Separately, the College's surveys found 8.8 per cent of patients reported delaying or avoiding GP care because of cost in 2024, up from 7 per cent in 2023 (RACGP, Health of the Nation, approx.), evidence that the affordability problem this policy targets was still worsening on the ground in the year the first incentive increase was meant to be taking hold.
The workforce behind the billing rate
A bulk-billing incentive changes what a GP is paid for seeing a patient. It does nothing, on its own, to change how many GPs exist or where they choose to work — and the evidence on that front is more troubling than the billing-rate recovery suggests. The RACGP's workforce data, drawn from the National Health Workforce Dataset, put the number of full-time-equivalent GPs at 112 per 100,000 people in 2023, down from 115 the year before (approx.), with wide gaps between jurisdictions: 116 per 100,000 in Victoria and New South Wales, but 106 in South Australia, 99 in Western Australia, 91 in the Australian Capital Territory and just 82 in the Northern Territory (RACGP, Health of the Nation 2024).
The pipeline feeding that workforce is narrowing at the same time demand is growing. Workforce modelling commissioned by the RACGP projects a shortfall of roughly 11,000 full-time-equivalent GPs — around 28 per cent (approx.) of the workforce the country will need — by 2032, against projected growth in demand for GP services of close to 38.5 per cent (approx.) over the same period, driven by an ageing, growing population with more chronic disease (RACGP-commissioned workforce modelling, cited in RACGP advocacy materials, approx.). Only around one in ten to one in seven medical graduates now nominate general practice as their first-choice specialty (approx.; RACGP and Medical Deans Australia and New Zealand commentary), a low uptake commonly linked to income: reporting on tax and workforce data has put typical full-time GP earnings at roughly half those of proceduralist specialties such as surgery or anaesthesia (approx.), and GP registrars, unlike hospital-based trainees, do not receive employee entitlements such as paid parental leave during their training years.
The geography of the shortage cuts against the simple story that more billing incentive automatically means better access. AIHW data for the first ten months of 2024 found bulk-billing rates were actually higher in very remote areas — around 88 per cent (approx.) — than in major cities, where the rate sat at around 77 per cent (approx.) (AIHW, Medicare bulk billing and out-of-pocket costs of GP attendances over time, patterns by remoteness). That is partly the incentive scale working as designed: the remote loading on the bulk-billing incentive is roughly double the metropolitan one. But rural and remote Australians still record higher rates of hospitalisation and death, including a mortality rate around 1.6 times the major-city rate, and use chronic-disease management services less than city residents (AIHW, Rural and remote health, approx.) — evidence that a strong local bulk-billing rate does not by itself mean strong access, when the deeper constraint is simply too few doctors within reach at all.
Medicare Urgent Care Clinics sit on top of this workforce picture rather than adding meaningfully to it; most are staffed by existing GPs and nurse practitioners working extended or additional shifts, not a newly trained workforce. Their volume is nonetheless real: on the government's figures, roughly a million visits were recorded in the network's first eighteen months, a substantial number of presentations that did not need to compete for a same-day GP appointment or an emergency department bed (Department of Health, Disability and Ageing, media statements, December 2024, approx.).
A bulk-billing rate is a number a government can move with a cheque. A GP workforce is not.
The critique: money that reached the billing rate faster than it reached the workforce
The clearest test of this policy is time. It took two rounds of the largest bulk-billing incentive increases in Medicare's history — $3.5 billion in 2023, and a further commitment costed near $7.9 billion in 2025 — spread across roughly two years, to lift the national bulk-billing rate back to somewhere near, but still below, its 2021-22 level, and not yet back to the artificially high COVID-era peak of 2020. Measured from the 2023-24 low point of 77.3 per cent to the most recent quarterly figure of around 81.4 per cent, the recovery so far represents roughly a third of the ground lost since 2021-22 being clawed back, for an outlay running into the billions of dollars a year. That is not evidence the policy failed; a genuine partial recovery, bought with real money, after a genuine multi-year decline, is a meaningful result. But it is evidence that restoring a headline billing rate to something resembling its earlier level is expensive and slow, even when the government throws the largest incentive increase in the scheme's history at the problem — a caution against treating the billing rate as a lever that snaps back the moment more money is applied to it.
The design of the original 2023 measure built a two-tier system into the policy by construction, not by accident. Restricting the tripled incentive to children and concession-card holders meant a GP had a strong new financial reason to bulk bill a pensioner and a much weaker one to bulk bill a working-age adult on a modest wage who held no concession card — precisely the warehouse worker from this piece's opening, and precisely the group most likely to delay care rather than find $40 or $50 on a given day. The RACGP's own reporting captured GPs raising this exact concern: low-income families who did not qualify for a concession card, including some single-parent households, were, in the College's words, at risk of "slipping through the cracks" (RACGP commentary, cited in trade and consumer reporting on the 2023 changes, approx.). The government's decision to extend the incentive to everyone in November 2025 is best read as an implicit admission that the original, narrower design had not solved the problem it was built to solve — it took a second and larger appropriation to reach the cohort the first one had left out.
Urgent Care Clinics answer a genuine access problem, but a narrower one than the incentive changes, and the two should not be conflated. A clinic that sees a broken finger or a child's fever on a Saturday afternoon is valuable, but it is not a substitute for an ongoing relationship with a regular GP who knows a patient's history and manages chronic disease over years — the kind of continuity of care that both MyMedicare and the RACGP's own advocacy identify as central to good primary care. With 87 original clinics and 50 more announced, the network will eventually number under 140 sites, against more than 6,000 general practices operating nationally; it is a meaningful new front door for episodic, urgent presentations, not a structural fix for the number of GPs available for ongoing care.
Most fundamentally, none of the incentive spending changes the size of the workforce delivering the care. A tripled, then universalised, bulk-billing incentive makes it more financially attractive for an existing GP to bulk bill an existing patient. It does nothing to make general practice a more attractive career choice for a medical graduate weighing a specialty that pays roughly double as much with better structured training conditions, and it does nothing to shorten a training pipeline that takes the better part of a decade to produce a new GP from a first-year medical student. Projected demand growth of around 38.5 per cent to 2032 against a workforce already projected to fall short by close to 28 per cent describes a gap that a billing incentive, however large, cannot close by itself. If the bulk-billing rate keeps recovering while the number of GPs per person keeps falling, the two numbers this piece has tracked will simply pass each other going in opposite directions: more visits nominally free, and longer waits or longer drives to get one at all.
The ongoing cost also compounds a pressure documented elsewhere on this site. Health spending sits alongside the NDIS, aged care, defence and interest as one of the areas of the Commonwealth budget growing faster than the economy as a whole, and a near-$2 billion-a-year, open-ended commitment to a universal bulk-billing incentive adds a further, permanent claim on that growth rather than a one-off cost that tapers away. That is not, by itself, a reason to withhold the money — access to a doctor is a reasonable thing for a government to prioritise — but it does mean the bulk-billing measures should be judged as a standing commitment competing for the same growing slice of the budget as every other structural spending pressure, not as an isolated announcement with no ongoing claim on future budgets.
What they got right, and the caveats
Credit belongs in several specific places. The government did not inherit a blank slate, and some of the ground it made up was ground previous governments — of both major parties — had allowed to erode. The Medicare rebate indexation freeze that did much of the underlying damage was introduced in the last Labor budget before the 2013 election, then extended for a further four years by the Coalition governments that followed, before being progressively unwound from 2017 and fully lifted by around 2020, also under a Coalition government (contemporary reporting on the Medicare rebate freeze, 2013-2020, approx.). Independent analysis by the Australian Medical Association estimated the freeze stripped in the order of $3.8 billion (approx.) out of the primary-care system over its life. The 2023-24 low point in bulk billing this piece measures against reflects the cumulative effect of a decade-long, bipartisan-origin funding gap and the sudden withdrawal of a temporary COVID-era support measure, layered on top of each other — not a decline this government alone created in a single term.
It is also fair to note the government did not simply announce a policy once and move on. Facing evidence through 2024 that the first, targeted incentive increase had not closed the gap for working-age adults without a concession card, it returned with a larger, genuinely universal expansion within roughly two years, backed by fresh funding rather than a re-badging of the earlier measure. That is a more responsive pattern than simply defending the original design regardless of what the data showed. The Urgent Care Clinic network, whatever its limits as a structural fix, has delivered a real, measurable service — a million visits in eighteen months is not a rounding error — and the rural and remote bulk-billing rate, already comparatively strong before either round of incentive changes, shows the remoteness-scaled incentive structure inherited from earlier reforms was broadly well targeted at the areas most exposed to distance from a clinic, even if workforce and access gaps persist there on other measures.
The caveat that matters most is about what a billing-rate recovery can and cannot prove. A rising bulk-billing percentage shows more consultations are free at the point of care; it does not, by itself, show those consultations were easy to get, timely, or delivered by a GP a patient has an ongoing relationship with. Both things can be true at once: bulk billing can keep recovering because existing GPs bulk bill more of their existing, capped patient lists, while genuine access — measured in appointment wait times, GPs per person, and the number of practices still accepting new patients at all — continues to tighten. The evidence assembled in this piece does not yet answer which of those two pictures will dominate by 2030, the year the government has set as its own target for nine in ten visits being bulk billed.
Free at the point of care and free of a doctor to see are two different promises. Medicare has only ever guaranteed the first.
The risk to the future
A recovering billing rate riding on top of a shrinking workforce
The forward-looking risk is not that the incentive spending was wasted — the evidence shows a real, if partial and expensive, recovery in the bulk-billing rate, achieved through policy levers entirely within a government's control. The risk is that billing rate and genuine access are being allowed to drift apart, because only one of them can be fixed with a cheque. A government can lift an incentive payment in a single Budget and see the national bulk-billing percentage move within a year or two, as this piece's evidence shows. It cannot train a new GP that quickly; the pipeline from a first-year medical student to a fully qualified GP runs the better part of a decade, and workforce modelling already has the country tracking toward a shortfall of close to three in ten of the GPs it will need by 2032, against demand projected to grow by more than a third over the same period.
If that gap keeps widening while the headline billing rate keeps recovering, the two trends this piece has tracked point toward a specific and quietly corrosive outcome: a Medicare system that looks, on the government's own preferred measure, more universal than it has been in years, while the lived experience of getting a timely appointment — especially for the roughly seven in ten Australians who are neither a concession-card holder nor a child, and especially for the outer-suburban and regional communities where GP numbers per person are lowest — keeps getting harder. A promise measured by what a visit costs, rather than by how long it takes to get one, can keep looking fulfilled on paper for years after it has stopped feeling true at the front desk.
For the next generation, the stakes compound. Today's medical students are the GPs the workforce projections say will fall short in 2032; the specialty-choice incentives working against general practice now — lower relative pay, a longer and less securely remunerated training path — will shape how many of them choose to become GPs at all, regardless of how generous the bulk-billing incentive looks by then. A country that keeps funding the demand side of primary care generously while leaving the supply side to a decade-long training pipeline is choosing, whether or not it says so explicitly, to bet that money alone can hold a universal promise together. The evidence in this piece suggests that bet is, at best, only half paid for.