Women from all age cohorts raised concerns with the reduction or lack of bulk-billing (no out-of-pocket cost to patient) medical services in their area.
In the days of bulk-billing (alas, no more) this service was free, but the last two episodes have cost $40 apiece.
Government reforms to the Medicare system in 2003 introduced incentives to medical practitioners to increase bulk billing rates, particularly in rural and remote areas, as well as in metropolitan areas with lower rates of bulk-billing [ 24].
This potentially creates a socioeconomic bias and underestimation of bulk billing rates [ 17].
7. Scale Efficiency, containing 11.8% of cases, have the most GPs, the smallest admin-to-GP and nurse-to-GP ratios, are on the upper end of bulk billing, and on the upper end of on-call.
4. Winding Down, representing 11.6% of cases, is mostly defined by GPs finding IT least useful in day-to-day practice, and are on the upper end of bulk billing and tend to be older.
In order to assess availability of "bulk billing" in general practice, one new item was developed to fit into the scale to assess the availability and accessibility of GP services.
Conversely, other participants chose to deliberately avoid bulk-billing doctors, reporting concerns with the perceived quality of care from bulk-billing practices, particularly large medical centres.
Restricted access to bulk-billing services (where there is no out-of-pocket contribution from the patient) was also of concern to providers given the low socio-economic status of a significant proportion of the CALD community.
The added burden of claiming a partial refund from Medicare for each non-bulk-billed consultation was mentioned by some of the 1921 26 cohort: " … I don't like to complain, please forgive me, but since bulk-billing and increase in lots of chemist prices, it is more difficult.
