News Room

Bulk or Mixed Billing?

Worldwide, Australia ranks quite highly in terms of accessibility to medical services, but equality in health care continues to generate more dinner conversations than ever before.

To mix or not to mix bill now serves as the entrée.

For GPs, the discussion surrounding the move toward mixed billing practices is one as varying as acutely as the patient’s opinion.

If a mixed billing arrangement gives patients more control over who they see, the amount of time spent and when, there should be smiles all round, right?

Not so for those who cannot afford the additional burden on already stretched incomes.

Could it be that socioeconomic factors of billing decisions is the elephant in the room?

Read on to learn my thoughts on bulk or mixed billing...

What Is Mixed Billing?

A mixed billing practice offers medical consultation and examination for a set fee. Fees payable are displayed or discussed up front, where required.

In a mixed billing practice, a certain amount of patients will be bulk billed. These are generally children, the elderly or those on an approved government benefit.

What is Bulk Billing?

An environment where no money changes hands, the bulk billing practice extends the required health care to the attendee. There is a standard ten minute appointment, which is billed to the government under the current Medicare system.

Many will see a bulk billing practice for a variety of reason, with convenience and cost being major factors.

Of Myths and Legends?

For some job seeking medical professionals, seeing patients entirely at the expense of the government may seem less appealing for than working in a mixed billing environment.

This conclusion may be a result of personal experience, colleague anecdotal evidence, or a combination of both.

Bulk billing centres would have seemed to be in greater quantities in areas of less educational advantage, and monetary affluence in the past. However, is this still true?

Other factors proving to not necessarily to be correct would be that a mixed billing or ‘fee for use’ practice would attract a nicer subsection of society.

Today, there is no such emphasis, and beliefs could be disproved by the current available data on such. It is now a conclusion that not all non-affluent areas consist only of bulk billing practices.

Another point proving to be somewhat of a myth is the fear for the GP that the bulk billed practice was not in receipt of the best medical equipment.

Large and extremely well funded, many bulk billed practices now have state of the art facilities, with resources and diagnostic tools not lacking.

The Devil You Know

Overseas GPs coming to Australia may see comfort in the familiarity of the current Medicare Bull billing environment, as it is much the same as the UK’s NHS scheme.

In terms of employment, working preferences vary with the range of patients in a bulk billing situation thought to provide a variety in range of patients and challenges.

This also can be a matter for debate.

Freedom of Choice

Being that socioeconomic factors, once thought to be directly linked to the bulk billing practice locations can now be argued, do patients really attend a medical practice because of its billing status?

If a selection of people were to be asked the question, the answers might be surprising.

Is it more pertinent that the practice be local in its proximity, hold a variety of GP’s both male and female, or available to make an appointment more important?

On the practitioner side of the argument, would it be a major consideration for a GP in his or her professional capacity, to partner with a mixed billing practice?

Some might say it is all about the overall experience with the practice and the GPs themselves that will keep the waiting rooms full.


Pros and Cons of Mixed Billing

From a GP and business decision point of view, the mixed billing arrangement may look good on paper, but be less popular with the public when put to the test.

Yes, there is opportunity for growth in income for the GP per patient, due to higher consultation fees. There is also the potential for scaled fees that may increase this financial position even further.

As an example, a practice may have a tiered fee structure. Normal hours have standard fees and out of ‘normal business hours’ consultations attract a much higher fee.

However, the risk must be considered that a mixed billing arrangement may detract patients who will then look for a bulk-billed alternative, sometimes out of area.

For users of medical services, the absence of choice would seem of some concern.

It cannot be overlooked that a bulk billing practice presents a fee-free medical environment, attractive to all who hold a current Medicare card.

The pros and cons vary, as do the policies of each practice.

Overall, the consensus is medical practices need to ensure the finest health care available to each patient, whenever they need it, regardless of how the bill is paid.

From Both Sides Now

For the GP looking to evaluate job opportunity or practice commencement, decisions would be based on merit, professional challenges and their own personal ambition.

If mixed billing centres are to be the future of medical practices throughout the country then this may lead to questions concerning equality of health among equally deserving citizens.

The arguments suggest that the mixed billing centres will reduce the amount of unnecessary visits to the GP, but may have an effect on those who cannot afford to pay hence avoiding medical attention when they are in most need.

In terms of patient requirements, it seems evident that more time with the GP and less pressure to be out in ten minutes is high on the wish list. Choice of practitioner and the convenience of attending when and where they want seems to be also important.

Can GP’s please all of people all of the time? Unlikely, but catering to everyone’s soaring expectations is not in question.

The opportunity to build a rapport and a create wellness in times of distressing ailments would seem the ultimate goal on both sides.

It appears this should be attainable in either type of billing practice.

Australia is a wealthy and fortunate country and will continue to be so through examination of alternatives that will benefit both professionals and patients.


Either bulk billing or Private billing what we all need to take away from this is that we need to look at the practice in terms of its environment, the surrounding practices, practitioners and services onsite and not just the socio economic status and the fee that could be received.  Find your point of difference to that of your competitors, the choice of billing will definitely not be the only thing a patient searching for a new GP is looking for.


Contact me today if you want to discuss business management, recruitment and HR services in the healthcare and medical sector.


About the Author

With an MBA specialising in finance and a Diploma in Practice Management, Ami is a driven and affable recruitment consultant recruiting in Healthcare, Medical and Allied Health.  With a passion for building relationships and helping businesses to grow, backed by a wealth of experience in all aspects of the medical centre including HR, OH&S and business management Ami is well-equipped to help you achieve your business goals.

Follow Ami on LinkedIn

Filter Results:
The Latest: