Despite declaring its Medicare co-payment "dead, buried and cremated," the Abbott government is considering proposals to give GPs the option of charging gap fees to bulk-billed patients.
Under the current rules, if a doctor bulk bills a patient, they must accept the Medicare rebate of $37.05 as full payment for the service. Alternatively, the doctor must forgo the Medicare rebate and charge the patient a higher fee upfront, usually about $70. The patient then claims the $37.05 rebate from Medicare.
A change to allow gap charges would reduce out-of-pocket costs for patients who already pay upfront to see their doctor, but would mean the end of free care for some patients, and some advocates predict the change would push up fees over time.
Despite last week jettisoning a planned $5 cut to Medicare rebates, Health Minister Sussan Ley is exploring alternative options to make well-off patients contribute more to the cost of their healthcare and reduce what she sees as unacceptably high rates of bulk billing among non-concessional patients. About seven in 10 services to non-concessional patients are delivered at no charge to the patient.
Doctors groups have long argued for the ability to charge gap fees without giving up the Medicare rebate, and such a change would give doctors the ability to recover income lost through a four-year freeze on rebate indexation.
Royal Australian College of General Practitioners president Frank Jones said the current rules forced doctors to absorb costs for items such as bandages and vaccines, which were used in treating bulk-billed patients.
"This can affect the viability of a practice. If services such as wound care and vaccination are not viable, the alternative would be having patients treated at a local hospital at a much higher cost," Dr Jones said.
He insisted the change would not affect disadvantaged patients, because GPs would ask for a contribution only from patients who they knew could afford to pay.
Australian Medical Association president Brian Owler said his organisation had long supported such a change, which he said would benefit patients who are currently privately billed, because they would not need to pay the amount of the Medicare rebate upfront.
Ms Ley said the idea was "something doctors across the country have consistently raised with me during my consultations and we'll obviously consider any realistic proposal that reduces upfront costs for patients and cuts red tape for GPs".
But this was only one of many ideas she was considering as part of wide-ranging discussions about "holistic" Medicare reform, and she wanted to ensure any future changes had "broad support from health professionals, patients, the public and Parliament".
Such a change would require legislation and could not proceed without the support of either Labor, the Greens or six other Senate crossbenchers.
Labor health spokeswoman Catherine King did not rule out supporting such a change but said her party would not be supporting "any legislation that drives up out of pocket costs and undermines Medicare and universal access to healthcare".
"Given the government is now on to its fifth version of the GP tax without ever once bringing legislation before the Parliament, we'll wait to see the detail, if any, of this latest proposal," Ms King said.
Greens health spokesman Richard di Natale said his party would vote against such a change, which he said would "be the end of bulk billing" and would "open the floodgates to huge out-of-pocket costs".
Palmer United Party Senate leader Glenn Lazarus said such a change would increase doctors incomes but "hurt everyday Australians".
Consumers Health Forum spokesman Mark Metherell said gap fees would "erode universal healthcare" and "be a further slide down the slippery slope to a two-tiered health system, where those who can afford to see the doctor have no problems with access, but those who can't face new barriers".