In the state that needs GPs most, they’re more out of reach than ever.

 Tasmania is our poorest and sickest state. And that fact magnifies Medicare’s worsening failure.

The federal government has just released figures which, for the first time, show the results for general practice attendances, rather than services. The old figures considerably and misleadingly boosted bulk-billing rates because services secondary to a consultation (for instance, a vaccination) might be bulk-billed while the consultation itself was not.

These new figures give us a much better idea of the way bulk-billing has declined over the past 13 years. Tasmania is second only to the ACT as the jurisdiction with the lowest bulk-billing rates. People in the ACT, though, are far more easily able to afford out-of-pocket costs than Tasmanians. In the ACT, average weekly disposable income is $1,406. In Tasmania, it’s $961.

All the figures in this analysis are for non-referred GP attendances excluding those for Covid-19 vaccinations.

Tasmanians have long been far less likely to be bulk-billed than other Australians. This chart shows how there has been a more gradual decline nationally since 2010-11 than in Tasmania, where rates tended to remain fairly stable. In the most recent period, though, Tasmanian rates have plummeted from 48.5% to 44.5%. That means that around 130,000 attendances were not bulk-billed in 2021-22 that would have been the year before.

As the numbers declined of people who are always bulk-billed, those who were sometimes bulk-billed rose. As practices reacted to the worsening cost squeeze, the number of patients in the middle (between “always” and “never”) rose.

A more detailed look at the figures shows how the mix is changing. Although the pandemic lockdowns distorted the patterns somewhat because many less-ill people avoided going to the doctor, the number of people who are bulk-billed more than 50% of the time is in decline, so more patients are being bulk-billed less than half the time or not at all.

In line with all these trends, the number of attendances paid for by the patient has risen, from 618,742 in 2013-14 (when the rebate freeze began) to 759,084 last financial year. That’s an increase of 23%.

Not only are the numbers of self-funded GP patients increasing; their out-of-pocket costs have also gone up even more sharply.

The average cost to a paying patient has risen from $23.90 in 2009-10 to $43.41 last financial year. That’s an increase of 81%. In that time, the consumer price index has risen by 29.5%.

So if out-of-pocket costs at Tasmanian general practices had risen in line with ordinary inflation, the amount would now be $30.95, not $43.41.

 In the absence of any coherent and timely intervention by the federal government, all these trends will inevitably continue. Tasmania, as before, will be the most seriously affected of all jurisdictions.