Rise of membership clinics across the country raise concerns of 'further decreasing accessibility of care'

Concerns have been raised that more Canberrans may soon have to pay for the privilege of seeing a doctor who offers bulk billing.

According to healthcare accessibility advocacy company Cleanbill’s January Blue Report, only 3.4 per cent of Canberra’s 98 clinics bulk bill, with an average out-of-pocket cost of $49.39.

That’s the second-lowest rate in the country, behind Tasmania. It compares to a national bulk billing rate of 24 per cent and an average out-of-pocket cost of $41.69.

However, during the report’s compilation, Cleanbill founder James Gillespie said they encountered a “new” type of GP clinic structure: membership clinics.

“Membership clinics are GP clinics that bulk bill all of their non-concession adult patients, provided these patients pay some sort of membership fee to access the clinic,” he wrote in Cleanbill’s recently released report specifically on this phenomenon.

“This is new.”

Membership clinics weren’t included in Cleanbill’s January report because of the upfront cost of visiting them.

It found there are 98 membership clinics across the country, with an average upfront cost of $77.94.

In the ACT, visiting Canberra’s only membership clinic costs $120 upfront, or $60 for those with a healthcare card.

The report stated that even though membership clinics could appear as an “equitable way” for GPs to remain economically viable while continuing to bulk bill, such fees may limit new patient accessibility.

“Under a membership fee structure, the out-of-pocket fees that would ultimately be paid to the clinic over a course of care are concentrated in the cost for an initial appointment,” it stated.

“While this is preferable for regular patients, any new patient seeking a one-off appointment has to cover a significant upfront cost to access the clinic that might otherwise be defrayed over multiple appointments.

“And because these clinics are regularly reported as, and listed on directories as, wholly bulk billing, this initial bill will come as a shock, further decreasing accessibility of care.”

The Canberra Liberals moved a motion in the Legislative Assembly on Wednesday (10 April) demanding the ACT Government present a plan by the end of the financial year to address what it called the “crisis in primary care” in the ACT.

Shadow Health Minister Leanne Castley said it was particularly concerning that the ACT’s membership clinic was charging a much higher upfront fee than those in other jurisdictions.

“This is one more indicator of the Labor-Greens government’s neglect of primary care,” she said.

“Canberrans are putting off seeing a doctor, spending longer in consultations on multiple issues, or going to emergency departments.”

The Canberra Liberals pointed to the government’s GP payroll tax as one symptom making the problem worse.

“Add in GPs burning out, retiring or cutting back on practice time and the difficulty attracting graduates to General Practice, and you have a recipe for a worsening crisis in primary care,” Ms Castley said.

“The Barr government needs to develop a practical, concrete plan to address this crisis now.”

Health Minister Rachel Stephen-Smith rubbished Ms Castley’s claims.

She said that while there is a membership clinic in Tuggeranong (which opened in 2019), paying the upfront cost was “significantly less” than what someone would pay for three average consultations.

“Clearly, Interchange Co-op members think this is value for money,” Ms Stephen-Smith said.

According to the Interchange Health Co-op’s website, members don’t have to pay for standard (up to 20 minutes), long (up to 40 minutes) or extended (more than 40 minutes) consultations, while such appointments would cost non-members $90, $150 and $220 respectively.

Ms Stephen-Smith also argued the ACT Government had done the “heavy lifting” of sustaining primary healthcare under the conditions of the former Federal Coalition governments – investing $16 million into primary healthcare since 2017.

“The reality is that primary care is a Commonwealth responsibility, and primary care is in the dire state it is because of 10 years of neglect … by the former Coalition government,” she said.

Ms Stephen-Smith also refuted the 3.4 per cent bulk-billing figure, insisting that “most [Canberra] GPs bulk bill”.

“That’s why more than 50 per cent of GP services are bulked billed [in the ACT],” she said.

The Health Minister summarised the government’s plan for Canberra’s primary healthcare system, saying: “We plan to work with the Albanese-Labor Government collaboratively and cooperatively, recognising its significant investment in primary care and the joint commitment, through National Cabinet, to the outcomes of the Strengthening Medicare Taskforce.”

Ms Castley’s motion was voted down by the Labor and Greens members.