Bulk billing of children and pensioners, as well as home visits to elderly and dying patients, could be scrapped in outer metro areas across Australia because of cuts which doctors say they will not be able to afford.

Key points: The bulk-billing incentive will be reduced in some areas from about $10 to $6 from next year

The bulk-billing incentive will be reduced in some areas from about $10 to $6 from next year Doctors say they could be forced to scrap bulk billing in outer metro areas

Doctors say they could be forced to scrap bulk billing in outer metro areas The health department says the changes will make the system fairer for rural patients

An incoming change to bulk-billing incentives has pushed GPs to breaking point, medical groups have warned, requiring them to provide crucial primary health services for less than the cost of a barber's cut.

The Federal Government has changed a key geographical classification, scrapping some outer suburban zones of incentives intended for rural areas.

From January 2020, the bulk-billing incentive in outer metro areas will be reduced from about $10 to $6 per patient, per visit.

The changes will affect GP practices in as many as 13 outer metro regions, including in Canberra, Adelaide's south, the New South Wales Central Coast, Geelong and the Mornington Peninsula.

The Australian Medical Association SA president, Dr Chris Moy, said many of the affected regions are low socio-economic areas.

He said the changes could put more pressure on already costly hospital systems, because patients could no longer afford to visit their GPs regularly.

"This is an example of a just a small change. It's not a huge change, but it's enough to break the camel's back," he said.

"It's more difficult for individuals to pay a gap in those situations so it's unfortunate this has happened."

Royal Australian College of General Practitioners president Harry Nespolon said general practitioners in the city and in the country were effectively being asked to work for free.

"The Medicare rebates are insufficient to provide the care that patients need," Dr Nespolon said.

"I don't think people want their GPs to do work for nothing but that's effectively what we're being asked to do.

"If the services become marginal in the sense they don't cover their costs, then they've got a choice — they can either go out of business or charge a fee.

"GPs in practices everywhere, rural or otherwise, are considering whether or not the current amount of rebate if they do bulk bill a patient is able to keep them in business."

Changes will benefit rural health, department says

The Health Department defended the changes, saying eligibility criteria needed to be updated to ensure country patients were given fair access to bulk billing.

"The changes are necessary so that geographical eligibility is updated from 1991 population statistics to contemporary models," a spokesperson said.

"This measure ensures that metropolitan areas will no longer be able to access incentives intended for rural and remote Australia ensuring that Australians living in rural and remote areas have better access to bulk-billing services."

The spokesperson said the implementation had been delayed by six months to give "practices time to adjust their business models".

Quick explanation of rebates The Medicare Benefits Schedule (MBS) is a list of medical services for which the Australian Government provides a Medicare rebate.

The Medicare Benefits Schedule (MBS) is a list of medical services for which the Australian Government provides a Medicare rebate. Each MBS item has its own scheduled fee — this is the amount the Government considers appropriate for a particular service (e.g. getting a blood test or seeing a psychologist).

Each MBS item has its own scheduled fee — this is the amount the Government considers appropriate for a particular service (e.g. getting a blood test or seeing a psychologist). Rebates are typically paid as a percentage of the Medicare scheduled fee. In the case of GP consultations, the rebate is 100 per cent of the schedule fee.

Rebates are typically paid as a percentage of the Medicare scheduled fee. In the case of GP consultations, the rebate is 100 per cent of the schedule fee. This means that bulk-billing GPs agree to charge patients the Medicare schedule fee ($37.60 for a standard appointment) and are directly reimbursed by the Government, and there is no cost to the patient.

This means that bulk-billing GPs agree to charge patients the Medicare schedule fee ($37.60 for a standard appointment) and are directly reimbursed by the Government, and there is no cost to the patient. GPs who don't bulk bill charge a fee higher than the Medicare schedule fee, meaning patients must pay the difference between the schedule fee and the doctor's fee — out of their own pocket.

GPs who don't bulk bill charge a fee higher than the Medicare schedule fee, meaning patients must pay the difference between the schedule fee and the doctor's fee — out of their own pocket. For example, if your doctor charges $75 for a standard consultation, you'll pay $75 and receive a rebate of $37.60 — leaving you $37.40 worse off.

But Dr Daniel Byrne, who works in Adelaide's south, said it could lead to a $70,000 hit to his practice's annual revenue, meaning he would have to scrap bulk billing.

For 28 years, Dr Byrne has visited patients who struggle to get to his practice in their homes.

"I thought it was a normal part of being a good GP to provide this care to elderly patients, frail, disabled and more importantly the palliative care patients," he said.

"I'm one of the few GPs who still does home visits."

Dr Byrne said he had always lost money on the visits but said the change to the bulk-billing incentive meant he could no longer afford to continue.

He said he would have to start charging consultation fees for children over the age of 10 and some pensioners who were previously bulk-billed.

"The research does show people will think twice about going to a doctor when they have to pay but that's beyond our control now because the primary care system is not being funded to enable us to continue bulk billing," Dr Byrne said.

"If you don't fund good primary healthcare you don't get the outcomes that the people of Australia would expect."

Dr Nespolon said the Medicare rebate freeze had cost general practice about $1 billion and called for that money to be reinstated to "the most important part of the healthcare system".

"If money isn't put into this we'll see a two-tiered health system: those who can afford and those who can't afford," he said.

"That's something we really don't want to see here in Australia."

Dr Chris Moy said patients would struggle to pay the increased gap. ( ABC News: Claire Campbell )

While freezes to the Medicare rebate were reversed at the most recent budget, Dr Moy said it was only being funded at half the level it needed to be.

"We're trying to fund good medical practice here at the frontline for about the cost of a man's haircut," he said.

"That means providing all the dressings, the equipment, the nursing staff, the administration staff … when the responsibility is a lot higher than at a barber's shop.

"Both sides of governments, they say 'wow it's great that the freeze has come off', but really they've unfrozen it at a level which is unsustainable."