Medicare Now Runs at Two Speeds: 94% Bulk-Billed in the Poorest Areas, 68% in the Richest

Australia’s most-quoted health statistic is finally moving the right way. After two years of decline, the share of GP visits bulk-billed — the patient walks out having paid nothing — has climbed back to 81.9% in the March 2026 quarter, up from a low of 76.5% in late 2023. The government points to the rise as proof its November 2023 decision to triple the bulk-billing incentive is working, and at the national level the department’s own figures agree.

That single number describes two very different countries.

In the most disadvantaged tenth of the country, GPs bulk-billed 93.8% of visits in the March quarter. In the wealthiest tenth, the figure was 67.5% — and still falling. The national average sits between them because it averages them, not because it is typical of anywhere. Sort the country’s Statistical Areas by socio-economic disadvantage and the bulk-billing rate lines up almost like a staircase: the poorer the area, the more of its GP visits cost the patient nothing.

The direction of that gradient is not a surprise, and should not be reported as one. The bulk-billing incentive is means-tested: it pays a GP more to bulk-bill a concession-card holder or a child, and those patients are concentrated in poorer areas. A higher rate where the incentive is worth more is the policy working as designed.

What the incentive’s design does not predict is the size of the gap, or its direction of travel. This analysis pre-registered the fear that runs the other way — that the retreat from bulk-billing would be steepest where patients can least absorb a gap fee. That prediction failed. Since mid-2022 the rate fell 10.1 points in the wealthiest tenth of areas and 1.8 points in the most disadvantaged, widening the gap from 18 points to 26. The practical consequence is that the national figure the government cites has stopped describing anywhere: it is the midpoint of two systems that are moving apart.

A staircase of disadvantage#

To see the pattern, this investigation joined the Department of Health’s quarterly GP statistics for each Statistical Area to the Australian Bureau of Statistics’ 2021 Index of Relative Socio-economic Disadvantage, the standard measure of area advantage built from Census income, employment, housing and education data. The join covers 328 areas and 98.5% of the country’s GP visits.

The relationship is strong. In the March 2026 quarter the rank correlation between an area’s disadvantage score and its bulk-billing rate is −0.65: as area wealth rises, bulk-billing falls. Plotted, every dot is one area, sized by the number of GP visits it generates.

The extremes are stark. In Mount Druitt, in Sydney’s west, GPs bulk-billed 98.8% of visits — all but about one in eighty. Neighbouring Fairfield and Merrylands – Guildford sit just behind, above 98%. At the other end, in South Canberra the rate was 44.4%; in North Canberra, 46.4%. In the wealthy coastal strip of Perth’s Cottesloe – Claremont it was 51.7%, and across Brisbane’s inner suburbs, 54%. These are not remote towns short of doctors. They are some of the most advantaged, doctor-dense areas in the country — and they are where paying to see a GP has become normal.

That a bulk-billing gradient exists is not new. A 2025 study in the Medical Journal of Australia found the same shape in 2022 data: bulk-billing of 86% in the most disadvantaged fifth of areas against 73% in the least. What the quarterly series adds is the direction of travel — and it is widening.

The fall skipped the poor#

Set each area’s current bulk-billing rate against its rate in the June 2022 quarter, the last quarter before the sustained national decline and after the pandemic telehealth surge had unwound. The drop is not shared evenly. It rises, almost monotonically, with wealth.

In the most disadvantaged tenth of areas the rate slipped 1.8 points, from 95.6% to 93.8% — near-universal bulk-billing, barely dented. In the wealthiest tenth it fell 10.1 points, from 77.6% to 67.5%. The correlation between an area’s disadvantage and the size of its fall is −0.54. The national retreat in bulk-billing is, to a large degree, a retreat in well-off suburbs.

Because the fall concentrated where bulk-billing was already lowest, the distance between rich and poor areas stretched. The gap between the most and least disadvantaged tenths widened from 18 percentage points in mid-2022 to 26 by early 2026. Tracked as the top and bottom fifths of areas across every quarter, the two lines separate visibly from 2022 on.

The turn in late 2023 is visible in the poorest fifth, which had drifted down with everywhere else and then steadied and lifted after the November 2023 change. That change tripled the incentive paid to GPs for bulk-billing concession-card holders and children under 16 — patients who are concentrated in disadvantaged areas. The department’s national “recovery” is, on this analysis, largely a recovery among those patients: the areas where they live rebounded, and the areas where they do not kept sliding. It is analysis, not a claim of intent, but the arithmetic of who the policy pays for and where the rate recovered line up.

When you do pay, you pay more than before#

Bulk-billing is binary at the front desk — the visit is free or it is not. For the 7.2 million March-quarter visits that were not bulk-billed, the second half of the story is the size of the bill. The average out-of-pocket cost on a non-bulk-billed GP visit has climbed from about $44 in mid-2022 to $61 in the March 2026 quarter, a rise of roughly 40%.

The gap fee itself is only weakly related to disadvantage — it is marginally higher in wealthy areas ($65 in the wealthiest tenth against $55 in the most disadvantaged), matching the MJA study’s finding of slightly lower gaps in poorer areas. The divide that matters is not the size of the gap. It is whether you face one at all. In the wealthiest tenth of areas, a third of GP visits now carry a fee; in the most disadvantaged tenth, closer to one in sixteen.

What could explain this instead#

A strong area-level correlation is a description, not a mechanism. There are at least four ways to read this pattern that stop short of “GPs are abandoning the middle class,” and each deserves stating.

It is concession eligibility, not a choice about wealth. The most likely driver is the structure of the incentive itself. Bulk-billing pays a GP more when the patient holds a concession card or is a child, and those patients cluster in disadvantaged areas. On this reading the gradient is a map of concession-card density, and the policy is working exactly as designed — near-universal bulk-billing for the eligible, market rates for everyone else. That is less a refutation than the mechanism; it does not change who ends up paying.

The pandemic baseline. Bulk-billing sat near 90% in 2020–21 partly because COVID-era telehealth items were bulk-billed at very high rates. Measuring the fall from that peak would overstate it. This analysis starts the comparison at the June 2022 quarter, after that surge had unwound, precisely to avoid the distortion — but any residual telehealth effect would flatter the early figures.

Where the visit is counted. The department’s SA3 figure reflects the patient’s area of residence. A GP practice in a wealthy inner suburb may serve patients from across a city; the geography of billing is not identical to the geography of clinics. The area-level pattern is robust either way, but it describes where bulk-billed patients live, not necessarily where the bulk-billing doctors sit.

Areas are not people (the ecological trap). These are area averages across 30,000–130,000 people. A wealthy area’s low rate does not mean its poorest residents are being charged; within any area, billing still turns on the individual patient’s eligibility. Area-level data can show the geography of bulk-billing without settling who, inside each area, pays.

None of these dissolve the core description. Bulk-billing is near-universal in the most disadvantaged parts of Australia and has become a minority of visits in the wealthiest, and the distance between the two has grown. The rising national headline is true and, read alone, misleading: it records a recovery banked disproportionately by concession patients, over the top of a steady retreat from bulk-billing among the working, non-concession majority.