The April Blue Report from Cleanbill, an online directory for general practitioners (GPs), has revealed a notable trend: a greater proportion of regional clinics are transitioning to a fully bulk-billing system compared to those located in metropolitan areas. This shift comes amid a continued increase in out-of-pocket expenses for patients attending non-bulk-billed appointments across Australia.
According to the report, patients visiting clinics that do not offer full bulk-billing are now facing an average out-of-pocket expense that is 13.5 percent higher than in previous years. The current average cost for a standard consultation is recorded at $49.23.
The report analyzes data from 6,900 clinics listed in Cleanbill’s directory and highlights that a larger number of regional clinics are adopting the full bulk-billing model than their urban counterparts.
Matthew Lillywhite, a public servant, shared his experience of traveling from the Australian Capital Territory to Melbourne to see his family GP, as it was more convenient than visiting local practitioners. In Canberra, the upfront cost for a standard consultation is $140, which includes a $40 Medicare rebate, marking a $40 increase from when he moved to the capital in 2023.
Lillywhite, who manages chronic health conditions requiring consistent monitoring, relied on affordable flights to maintain access to his bulk-billing doctor in Melbourne. However, he has since lost access to these low-cost flights, making it challenging to balance his health needs with the increasing costs of medical care in Canberra. He expressed concern that the perception of universal healthcare is fading in the region.
Despite a significant salary increase that has reduced the percentage of his income spent on GP visits, Lillywhite finds himself assisting classmates who struggle to find bulk-billing clinicians, either by covering their medical expenses or driving them to appointments that would otherwise be inaccessible due to distance.
The Blue Report categorizes clinics using the Modified Monash (MM) system, which ranks locations from major urban centers (MM1) to very remote areas (MM7). The findings indicate that patients in very remote regions who do not use bulk-billing are incurring the highest average costs, with out-of-pocket expenses rising to $56.54 per appointment in 2026, an increase from $50.50 in the previous year. In metropolitan regions, patients not on the bulk-billing system are now paying an average of $48.89, up from $42.79— a 14.3 percent rise.
The report noted that while metropolitan areas experienced cost increases, medium-sized rural towns faced even steeper hikes, with average costs rising from $44.21 in 2025 to $50.25 this year. However, specific data for Canberra was not included, although earlier reports suggested that only about 10 percent of clinics in the ACT offered full bulk-billing.
Federal Health Minister Mark Butler has questioned the reliability of Cleanbill’s analysis, stating that the specific data from the report should not be considered accurate. He emphasized that since November 1 of the previous year, over 3,700 medical practices have shifted to fully bulk-billing, of which more than 1,400 were previously mixed-billing. Butler also noted that approximately 97 percent of Australians live within a 20-minute drive of a bulk-billing clinic.
Despite rising costs, the report indicates that regional and remote areas are significantly contributing to the recent growth in bulk-billing practices. The percentage of clinics offering full bulk-billing for standard weekday appointments has almost doubled over the past year, increasing from around 20 percent to over 40 percent. Regional centers, medium-sized rural towns, and remote communities have shown greater increases in fully bulk-billing clinics compared to metropolitan areas, which saw the lowest percentage increase at 16.8 percent.
Caroline Johnson, a GP and associate professor at the University of Melbourne, expressed her concern about the emerging “two-tier” healthcare system in Australia, where access to bulk-billing is becoming selective based on one’s ability to pay upfront costs. She emphasized that this trend undermines the foundational principles of Medicare.
The Royal Australian College of General Practitioners (RACGP) acknowledged that the data reflects an increase in bulk-billing where funding aligns more closely with the actual costs of care. Dr. Michael Wright, president of RACGP, noted that the rise in bulk-billing in regional areas indicates that improved funding is crucial to expanding access to healthcare.
In summary, the findings of the April Blue Report highlight the mixed landscape of healthcare access in Australia, with rising costs and regional disparities posing challenges to maintaining a truly universal health system.
