Health inequity has worsened under the government’s new bulk billing incentives, according to a Grattan Institute policy brief released ahead of the budget.
Authors Peter Breadon and Molly Chapman make the case that previous policy which limited bulk billing incentives to children and concession card holders “was the closest thing mainstream GP funding had to a needs-based adjustment.”
“It wasn’t much, but it did direct more money to clinics with more disadvantaged patients,” they write. “Expanding the incentive to all patients removed that.”
Following the November 2025 changes, the proportion of bulk billing incentives that go to the most disadvantaged areas has dropped, while the proportion of incentives going to the least disadvantaged has risen, they say, citing Australian Institute of Health and Welfare data.
“It is no surprise that immediately after the change, the share of incentive spending going to wealthier areas increased, at the expense of the poorest,” Breadon and Chapman write.
While other countries such as Denmark, Sweden, the Netherlands and New Zealand factor disadvantage into funding decisions, the changes in Australia have made funding less fair, they argue.
Moreover, subsidies in rural and regional areas are “crudely targeted and essentially arbitrary,” they add.
They point out that there are vast differences in wealth, health and access to care within the location categories.
“For example, almost one in five regional centres are in the top quarter of the country for GP services per person. Some small towns have excellent access, while others are in crisis.”
“Meanwhile, the areas with the least care – ‘GP deserts’ in the bottom 5% for services per person – actually had service levels fall after both boosts to the incentive. They also had the smallest increases in bulk billing,” they write.
The report strengthens the argument that the government’s bulk billing policy changes have had unintended consequences – including disproportionately benefiting male GPs and worsening the gender pay gap as the pay per minute for shorter consultations works out much higher than for longer consultations – and the average male GP sees more patients per day than the average female GP.
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