Practice Economics
Why Australian GPs are leaving bulk billing for private and home visit models
Bulk billing was meant to guarantee access to free GP care. A decade of rebate stagnation has instead pushed it toward collapse in many markets - and pushed GPs toward models that do not depend on the rebate at all.
Cleanbill's 2025 data found the adult bulk-billing rate near 20.7 percent nationally in early 2025, down from 35.1 percent in 2023. A $7.9 billion government incentive from November 2025 aims to reverse the slide, but it is voluntary and many GPs remain wary after the 2013 to 2019 rebate freeze. GPs are responding by moving to private billing and platforms such as C.A.L.L.S, where the fee is set by the GP, not capped by Medicare.
How bulk billing got here
Bulk billing depends on a simple equation: the Medicare rebate has to cover the real cost of the consultation for a GP to bulk bill without a loss. That equation broke down during the 2013 to 2019 Medicare rebate freeze, when the standard consultation rebate was held largely flat in nominal terms while rent, staff wages, insurance, and compliance costs kept rising. GPs who kept bulk billing through that period effectively took a real pay cut every year the freeze continued.
The effect has compounded since. Cleanbill's national GP clinic survey found the adult bulk-billing rate at around 20.7 percent in early 2025, down from 35.1 percent in 2023, with average out-of-pocket costs for a standard consult rising from roughly $41 in 2022 to $44 in 2025. In some states the fall was sharper still - NSW dropped from 49 percent bulk billing in 2023 to 34.5 percent in 2025.
What it costs patients
The patient-facing consequence is straightforward: cost is now a barrier to seeing a GP for a growing share of the population. Reporting drawing on the same Cleanbill data put the number of Australians avoiding a GP visit due to cost at over 1.5 million in 2024, up from around 600,000 in 2022. A system designed to guarantee free access at the point of care is, in a growing number of postcodes, no longer doing that.
Why the 2025 incentive has not solved it
From 1 November 2025, a new $7.9 billion incentive package came into effect to encourage GPs to bulk bill every consultation, not only concession card holders and children. It is the largest such investment in Medicare's history. But the scheme is not compulsory, and many GPs have told the media they will not be signing up, citing the risk that a future government could freeze rebates again, as happened between 2013 and 2019, leaving them locked into a lower-margin model with no way out.
That hesitation is rational, not obstructive. A GP who restructures their practice around bulk billing today is betting their income on a policy setting a future government could reverse. Many are choosing not to make that bet twice.
Where GPs are moving instead
The alternatives GPs are turning to share one feature: they decouple income from the Medicare rebate. Private billing and mixed-billing clinics let the GP set a fee closer to the real cost of care. Home visiting platforms go further - C.A.L.L.S has no rebate cap at all. Visits are booked in 30-minute time slots, the GP sets the consultation fee directly, commonly 150 to 350 dollars depending on complexity, keeps 100 percent of it, and pays only a flat monthly membership regardless of visit volume.
For a GP tired of watching real income erode every time a rebate freeze is threatened, that structure removes the dependency entirely. Income is set by the GP's own fee and workload, not by a rebate schedule decided in Canberra.
The income comparison
| Model | Fee source | Volume needed for a full day's pay |
|---|---|---|
| Bulk billing | Medicare rebate, capped | 25-30 patients |
| Private/mixed billing clinic | GP-set fee plus rebate, minus room overhead | 15-20 patients |
| C.A.L.L.S home visits | GP-set fee, no rebate cap, no commission | 6-8 patients |
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Apply to join C.A.L.L.SFrequently asked questions
Why are GPs moving away from bulk billing in Australia?
A decade of Medicare rebate stagnation, including a 2013 to 2019 freeze, left the rebate below the real cost of running a practice. Cleanbill's 2025 reporting found the adult bulk-billing rate near 20.7 percent nationally, forcing many GPs toward private or mixed billing to remain viable.
Did the 2025 Medicare bulk-billing incentive fix the problem?
Not fully. A $7.9 billion package from November 2025 aims to lift bulk billing, but it is voluntary and many GPs remain wary after the earlier freeze cut their real income for years.
What are GPs doing instead of bulk billing?
Moving to private billing, mixed-billing clinics, or platforms like C.A.L.L.S that pay per consultation at a GP-set fee rather than a capped rebate.
How does home visiting through C.A.L.L.S compare to bulk billing on income?
GPs set their own fee, commonly 150 to 350 dollars per visit, and keep 100 percent of it after a flat membership. Six to eight visits a day can match or exceed a bulk-billing roster of 25 to 30 patients.