The latest Medicare utilisation figures show the rate of bulk billed optometry services in Australia has remained high and stable compared to other health disciplines such as GPs.
However Medicare items are insufficient to cover the true costs of providing quality eyecare, advocates say.
The Federal Government released its quarterly Medicare statistics (September quarter 2022-23) which show 94.3% of optometry services were bulk billed in the quarter, which is consistent with statistics back to 2014-15 when there was a noticeable drop from the 97% rate.
Optometry Australia (OA) interim CEO Ms Skye Cappuccio said optometry has long been one of the highest bulk-billing professions.
“There are a number of reasons for this, including perceptions – perhaps not fully founded – about the willingness of patients to pay out-of-pocket costs for optometric care. Removal of the ‘cap’ on fees optometrists could charge for Medicare- subsidised services (which OA was successful in securing in 2015) did result in a small drop in bulk billing,” she said.
“Whilst bulk-billing for Medicare- subsidised services remains high, anecdotal evidence suggests that more practices are billing privately for services not covered by Medicare.”
When an optometry patient was charged an out-of-pocket cost, the average amount paid was $34.
For specialists, which include ophthalmologists, the data unsurprisingly showed the minority of patients were bulk billed at a rate of 30.6%. In the 5.9 million services that involved billing a patient, the average out-of-pocket cost was $101 per service.
GPs have been particularly concerned about their diminishing ability to provide bulk billed care. GP non-referred attendances were bulk billed 83.4% of the time in the latest figures. This is significantly lower than the corresponding 2021-22 quarter at 89.6% and the peak in the 2019-20 June quarter at 92.5%.
“[GP] practices are under strain, and many are making the difficult but necessary decision to stop bulk billing some or all of their patients and move to a private or mixed billing model,” Royal Australian College of General Practitioners president Dr Nicole Higgins said.
“This follows many years of under-investment in general practice care including the six year-long Medicare rebate freeze.”
Optometry was first included on the Medicare Benefits Schedule (MBS) in 1975. But since 1997, adjustments to the optometric MBS have continued to significantly lag behind CPI, Optometry Australia said in June 2022 when indexation was increased by a “modest” 1.6%.
This came after a freeze in indexation for optometry between 2013 and 2019, plus a 5% cut to MBS rebates introduced by the government in 2015, which OA says has resulted in Medicare rebates in real terms being a decade behind where they should be today.
Cappuccio said the lengthy freeze on indexation of Medicare items, and inadequate indexation that isn’t aligned to increasing costs to provide healthcare, mean that many optometry Medicare items are insufficient to address the true costs of providing quality optometric care.
“We continue to advocate for fairer indexation. We also encourage and support practices to charge fair fees that cover the true cost of providing such care – and have extensive resources online to assist members in making this transition,” she said.
In the latest quarter, there were 2.6 million optometry services provided, which is the fifth highest number since records began in 2009-10.
The figure is considerably higher compared to 1.9 million optometry services provided in the corresponding 2021-22 quarter (when COVID limited public access to optometry), and the 2.3 million services provided in the 2018-19 September quarter (pre pandemic).
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