Australia uses a mixed payment system for reimbursing general practitioners (GPs). To make care accessible, many GPs accept the lower Medicare Benefits Schedule Rebate (MBSR) as full payment for their services. This “bulk billing” results in zero copayments for patients but reduces GP earnings potential. In 2014, the MBSR was frozen, threatening the long-term financial sustainability of low-copayment general practices. Since 2021 GP bulk billing rates have fallen. Current policy attempts to increase bulk billing rates from currently 78% to 90% are unlikely to be achieved. What are the trade-offs that high-intensity bulk billing GPs make to ensure that people access health services free of co-payments? This study explores the job satisfaction consequences for high-intensity bulk billing GPs overall and after the MBSR freeze. We use ten years of data from a longitudinal survey of Australian doctors (MABEL) and widely accepted panel data econometrics methods.
We find that increases in bulk billing intensity are significantly associated with reduced job satisfaction. There are no significant heterogeneities by socio-demographic factors, but job satisfaction penalties are concentrated among the high-intensity bulk billing GPs. Increased workhours and poorer health status, a likely secondary effect, are the dominant confounders through which bulk billing intensity reduces job satisfaction. Our analysis of the MBSR freeze policy suggests that the freeze causally reduced job satisfaction, especially so for female GPs.
Policy attempts to raise bulk billing rates are likely to fail due to current incentives and trade-offs that GPs face with the current rebate and practice costs.