Senate Community Affairs Legislation Committee, , 0:00 to 21:04
The committee examines the government's 90% bulk billing target for 2030 and the modeling used to project practice incentive impacts.
Topics: Health, Integrity
Speakers: Penny Shakespeare, Hon Anne Ruston, Dorinda Cox, Hon Jenny McAllister, Unknown Speaker, Blair Comley PSM, Graeme Head AO, Speaker 6
Uh I declare open this hearing of the community affairs legislation committee into the 202526 additional estimates. I begin by acknowledging the traditional custodians of the land on which we meet today and pay my respects to their elders past and present. I extend that respect to Aboriginal tourist lander peoples here today. The committee has fixed Thursday the 9th of April 2026 as the date of return from the answers to questions taken on notice. The committee would appreciate if senators could please provide any written questions or notice to the secretariat by Thursday the 19th of February 2026. The committee's proceedings today will begin with the department of health, disability, and aging under outcome to individual health benefits. The committee will be conducting today's hearing in person and via te uh video conference. Understanding order 26, the committee must take all evidence in public session. This includes answers to questions on notice. I remind all witnesses that in giving evidence to the committee they are protected by parliamentary privilege. It is unlawful for anyone to threaten or disadvantage a witness on the account of evidence given to a committee and such action may be treated by the Senate as a contempt. It is also a contempt to give false or misleading evidence. The Senate has endorsed the following test of relevance questions to at estimates hearings. Any questions going to the operations or financial positions of the departments and agencies which are seeking funds in estimates are relevant questions for the purpose of estimates hearings. I remind all officers the Senate has resolved that there are no areas in connection with the expenditure of public funds where any person has a discretion to withhold details or explanations from the parliament or its committees unless the parliament has expressly provided otherwise. The Senate has also resolved that an officer of a department of the Commonwealth shall not be asked to give opinions on matters of policy and shall be given reasonable opportunity to refer questions asked of the officer to superior officers or to a minister. This resolution does not preclude questions by asking of explanations of policies or factual questions about when and how policies were developed uh sorry were adopted. uh witnesses are reminded uh of the Senate's order specifying the process by which a claim of public interest immunity should be raised. I incorporate the public interest immunity statement into the Hansard. I want to specifically remind all senators of their obligations under the behavior code for Australian parliamentarians to treat witnesses with dignity, courtesy, fairness, and respect. An officer called to answer a question for the first time should state their full name and the capacity in which they appear. I remind committee members and witnesses who are appearing via video conference and who are not speaking to mute their microphones. Live captions will be enabled for the entire duration of today's hearing. The feed will be displayed on selected video conferencing monitors at the witness bench and at the back of the room and in the waiting room. We ask witnesses to please inform the secretariat if at any time during the hearing you're experiencing any issues and they will endeavor to troubleshoot them as quickly as possible. It gives me great pleasure to now welcome Senator the Honorable Jenny McAllister, Minister for National Disability Insurance Scheme representing Minister for Health, Disability and Aging. Minister, do you wish to make an opening statement?
>> No, thank you chair.
>> Thank you. I also welcome back the Secretary of the Department of Health, Disability and Aging, Mr. Bear Conley PSM. Mr. Comley, do you wish to make an opening statement?
>> Uh, no. Thank you, chair.
hearing I I would hope to make a brief opening statement about the NDIS, but it seems more sensible to do that at that point in the program.
>> Yes, that's great. Thank you. Thanks, Minister. Um, I now call officers from the Department of Health Disability Aging in relation to outcome to individual health benefits. and I will invite questions. Um, Senator Austin, do you have
>> Thank you. Thank you very much. Um, could I ask some questions about the um the bulk billing targets? Thank you. Um, I'm I am really starting to wonder whether we're having Groundhog Day because I'm going to ask you exactly the same questions that I've asked you for the last three estimates in relation to um the announcement um when uh the additional funding was put into um expanding the bulk billing uh initiative in Australia where the government said that they were anticipating that they would have a bulk billing rate of um 90% by the end of the the decade. Um I asked you at the last two estimates if you are in a position to be able to provide me um with the um now I don't mind what you call them the targets the estimates the whatever the word you want to use let's not be tricky about words about what you thought uh what was the the model or the or the target trajectory of the increase in the bulk billing rate from when the initiative started to when you were hoping that or it was anticipated that it'll be at 90% by 2030. Do you have those yearon-year
>> Penny Shakespeare, Deputy Secretary Health Resourcing. Uh so some of the information about the uh annual estimates was provided at our hearings on the 4th of December. Uh so that's at page four of the handside record for the hearings. Uh and we can provide that to you. Uh so that had the yearly breakdown uh for the estimates uh for both the bulk billing incentive program and the bulk billing incentives under the Medicare benefit schedule. Uh we've provided further information uh in response to your questions on notice. So I think uh the most relevant one is uh Senate estimates question on notice 3163 from 25. Uh so can take you through some of the information that was contained in
there as well. All I'm looking for is um a document that shows the bulk billing rate is here on the date of the initiative with November 2025 when it whatever date you've got in 2030 when you believe you're going to get to 90%. What is the trajectory? Do you have
>> We have uh a target for the bulk billing rate by 2030 of 90%. >> No, no previous targets have been set by any government for bulk billing rates on an annual basis or other basis uh for uh the Medicare bulk billing rate. So this is the first time a government has set a target for bulk billing.
>> Yeah, sure. I I understand that and it's been announced and commented on a lot of times totally accept 90% by 2030. We had 77% or whatever it was when it this initiative commenced. Um and it said this initiative is estimating that we will be at 90% in 2030. None of us are disagreeing with that. I just want to know what the line is. Does it go up and then sort of plate off? Does it go in a straight line? Are you expecting all of it to happen in the last 2 minutes? What is how did you get to 90% in 2030? what what was the assumptions in along the way um that I said this is going to increase by the because quite frankly all I want is is the modeling to show how what is the trajectory to get to 90% by 2030 that's all I want
>> uh so as as set out in that Senate estimates question on notice response 3163 in preparing the impact analysis for this measure which set out our assumptions um and informed formed government decisions about whether or not to implement these measures. Uh the department estimated these initiatives will cause the GP bulk billing rate to increase by 10.5 percentage points by 2028-29. Um that's set out in more detail at pages 39 and 56 of the published impact analysis. Uh this included an estimated 4.5 percentage point increase to bulk billing rates due to the expansion of eligibility for bulk billing incentive items. Uh this is underpinned by an assumption that the bulk billing rate for patients who are currently ineligible for a bulk billing incentive would increase by 10 percentage points. Uh this assumption was based on the observed difference in bulk billing rates between concessional and non-consessional patients who were eligible for bulk billing incentives due to their age and further adjusted to account for trends in bulk billing by patient age. The department estimated that the bulk billing practice incentive program would lead to a further 6 percentage point increase to the GP bulk billing rate by 2028-29. Uh this impact is dependent on the expansion of the bulk billing incentives uh as B those bulk billing incentives that we discussed earlier uh reduce the earnings gap between bulk build and privately build services. The department estimated that around 4,800 general practices would be financially better off if they joined the bulk billing practice incentive program and bulk build all GP non-referred attendance services for Medicare eligible patients. The department used Medicare claims data to build an income model for each of the 6,600 general practices registered with the practice incentive program. The model considered each GP providers and practices revenue from MBS benefits, bulk billing incentives and patient So we've got quite detailed uh explanation of the assumptions. It does not include a trajectory for bulk billing rates. we've our modeling and assumptions were on uh different factors.
>> Okay. So, in terms of the um the bulk billing rates and the number of fully bulk build practices cuz they're the two metrics that we've got here. Um you have no you had no number of either the bulk billing rate or the number of practices that were likely to join up. No, we have
numbers >> annual numbers in the impact analysis for the uh number of practices we expect on it expected on an annual basis to join the program that is set out at page 61 of the impact analysis that I said
Okay. So you don't have a target of what you were expecting today.
uh I'm sorry a target of
>> expect so you couldn't actually go in at any point in time and say we were expecting that this will be the target at these particular times they're just the sort of like their annual targets for one thing no annual targets for bulk
>> uh so we had annual estimates of numbers of practices that would join the bulk billing practice incentive program they have been published >> uh and we are currently exceeding uh those published estimates
>> so did you model the incentive program.
>> Yes.
>> And is that available?
>> Uh so that's explained at the question on notice response 3163 and also in great detail in the impact analysis.
>> Okay. So just really it it seems very interesting that we don't seem to be able to get any granular detail about this, but the minister's out there quoting that, you know, we're well ahead
um as I said numbers of practices that were expected on an annual basis to join up to the practice incentive program. Those are published at page 61 of the impact analysis. Uh the target not it was not a target I should say the estimate for 202526 in terms of number of practices joining joined was 1,63. So we know that the number of practices that have registered so far is in excess
keep trying to get the information but it seems like it's not very easy to get. So in that impact analysis can I just so the the bulg billing rate target metric whatever you want to call it was 87.8% by 2829. That's the 10% increase that you were
87.8. Yes, that's correct.
>> 87.8. Yep. And 3,600 GP practices come fully bulk build clinics by 2028.
>> I'd have to check back with the impact.
>> Senator Mark Rod, first assistant secretary, primary care division. Yes. 3,600 practices expected to sign up by 202728.
>> Okay. And 4,800 by 20 uh 2930
>> uh by 2829.
>> 2829. >> And is that where it maxes out or have you got further data past that point?
>> No further data past that point. So
>> Okay. So the the bulk billing rate goes to 2030 but the um practice incentive only goes to 29.
the estimates of take up.
>> Yep. Yep. Okay. Um and it also projects a 50% decrease in total out-ofpocket costs for GP non-referred. Is that
>> Yes, that's what the model the policy impact statement said. Senator Daniel McCabe versus assistant secretary Medicare benefits and digital health
like formal targets once you've got out
No, I think the others can offer, but there are no formal targets other than the 2030 target of 90%, all the other things we're talking about are estimates that underpin what we anticipate happening based on the modeling, but
>> Yeah. So, okay. So the question is what is the government going to be measured against in relation to this particular before that time. So if I I mean I accept we can't be measuring anything yet that we need time and I'm I'm not being critical and and and clearly there has been an an uptick and this is all good because we want Australians to be able to get access to um more affordable healthare. Um, so no criticism in in in that front, but I'm just trying to understand how do we how do we measure in the middle of next year as an example the success or otherwise of this
taxpayers money and I can't find any measure by which the government is prepared to stand by in terms of the success or failure of this initiative. you know what what what was expected in terms of success. You can't have a success measure in 2030 because there's nothing to measure it against on the way through. So what what are the metrics by which you you are expecting to measure the success or otherwise of this program before you get to these these sort of more formally um numbers for 28.
Senator, as as set out in the impact analysis, it does require um the department uh to include information about how uh measures will be evaluated. Uh and we've explained how we would establish evaluation plans uh as the the measure is implemented. Uh I think the next key decision point as set out in that impact analysis uh in terms of having the uh evaluation plan uh worked up and then and then put into place is 2027.
>> Okay. So when when will we see the metrics that that evaluation plan will be measuring it against?
>> The department is working on that at the moment and you know there will be um metrics that we need to develop uh at a at a national level. We also need to make sure that we are able to evaluate how the measure is impacting um in particular uh communities and regions. >> Uh so you know this is a complex evaluation uh and we need to develop it properly. We've set out information about how we plan to do that and the time frames for uh developing the evaluation plan in the impact analysis that has been published.
>> Can you just walk me through this? So you're in the process you're starting the process to develop an evaluation plan. So when when do you expect to have that evaluation plan finalized in terms of understanding what it is that you know the metrics of of your evaluation process?
>> Uh so I think as set out in the impact analysis uh the key decision point for the evaluation plan metrics uh is later this year uh and then um implementation from the following year.
>> Okay. So when do you expect to have that reported back? Like so working through it this year to design the the the framework in which you're going to measure. You're going to put it into the you implement those that plan in 2027. When do you anticipate that you will have the findings of that evaluation? uh
so I do think that depends on uh you know the extent of the metrics in there how we're going to collect uh the information how we're going to conduct the evaluation is it within the department do we get independent involvement uh so I'm I'm not sure at this stage but we can certainly uh provide you on notice the information about uh the evaluation plan that was included in the impact analysis that's also published though and it's available to anybody to see um and you know we'll keep you updated. We're certainly monitoring very closely all of the data. We uh have NBS data published on a regular basis uh and there's a lot of interest in these measures. Uh so we'll be continuing to make information available about how it's tracking uh ahead of the formal evaluation.
>> And perhaps I can say Senator Ruston, of course there is substantial interest in Medicare because it is a prized and muchloved Australian institution. And I was pleased to hear you indicate that the coalition now supports an increase in bulk billing because your previous proposition as I understood it was that uh bulk billing was unsustainable. Um but in terms of the published data that came out,
of information where I that the coalition's position was bulk billing was unsustainable?
>> I think it was your public comments about the public health system being unsustainable. Senator Ruston, you're welcome. Senator, you need to verbal me.
>> Senator Ruston,
>> I'm finding it quite offensive. I'm being verbal. The minister is actually saying something that I've never said.
Senator, if you're saying that it's unsustainable, but anyway, I was the if you say that that is not your position, that's terrific and I accept that.
>> So, um sorry, Minister. So, um I I'm okay for you to to ask for for that to um or to challenge that even. But while the minister is providing her statement, um if um we cannot interrupt and go back and forth in that that would be helpful. Um you you will get the call back um once the the minister has finished speaking. So um I'll give the call to
you, Minister. Um but Senator Ruston um the part the recently published data is obviously very encouraging. So as the officials have indicated the estimates of where we expected to be in terms of practices are set out in the impact analysis. Um and we uh expected to be at around 3,600 practices in 2028. You know it's 3 months in. We're quite close to that. that is a positive outcome for Australians. Uh they were facing a situation where bulk billing was in freefall at the end of the last uh the Liberal government period. Uh we are now seeing a turnaround and I think Australians will think that that is a very good outcome.