‘Treated as a third-class citizen’: patients who need Medicare most struggle to find a GP who bulk bills

"I don't understand why all my bones and all of my organs are not covered by Medicare," says Megan Watts. "It's very frustrating."

Watts, 56, lives in the ACT, where GP bulk-billing rates are some of the worst in the country. In her local area of North Canberra she is not aware of any GP clinics that bulk bill people without a healthcare card.

Watts works 15 hours a week as an administration officer for her local Anglican church and has multiple health conditions. She says she goes to the GP for script renewals about six times a year.

"But then you add in the flu shot, and the fact that I have a chronic back condition that flares up, at which point I need serious painkillers," says Watts. "My mental health care plan requires regular renewal - and those require long appointments. It all adds up."

Watts estimates her out-of-pocket costs just to keep herself healthy add up to nearly $2,000 a year. And she considers herself lucky.

"There are so many people who have it worse than I do," she says.

Stories like Watts' are common. Guardian Australia has heard from numerous people whose bulk-billing doctors have announced recently that they will now charge for appointments. Patients are finding it increasingly difficult to find a GP who bulk bills, with some people in regional areas travelling long distances to access affordable care.

Department of Health data tabled in the Senate in 2019 showed that an average of 39.1% of patients in the ACT had their GP visits bulk billed, with an average out-of-pocket cost of $45.19 a visit.

When Guardian Australia requested updated data on bulk-billing rates across the country, the department declined to supply it.

But Dr Tim Senior, a general practitioner who regularly works with people experiencing poverty, says with the rising cost of living and freezes on Medicare indexation, the system has hit "a perfect storm".

"Medicare looks expensive because an awful lot of money gets spent on it, but if you don't have it, it's much more expensive," Senior says.

He says good primary health care systems - in which patients see a GP in their local community who knows them well - have been shown to be fairer, more effective and to cost less than secondary care, which involves hospital visits and referrals to specialists. "It feels like we're accidentally wandering into a secondary-care-based system."

Senior is also concerned about a general reluctance to acknowledge poverty as a key factor in health inequity, noting that the clinics in areas where bulk billing is most needed are also those where there is the most pressure to maximise Medicare funding to make ends meet.

"To make Medicare pay, you need lots of short consultations, which is exactly what you don't need in vulnerable communities," Senior says.

"Chronic diseases are more common in people who have less money, disability comes in at a younger age, and people have more complex interacting conditions, and you need longer consultations for those."

Joe, who asked that his surname not be used, lives in Victoria's Latrobe Valley. The 64-year-old has chronic obstructive pulmonary disease and a number of other conditions that require regular medical attention. He's on the disability pension.

"I stay with the one medical practice," Joe says. "They try to help me out as much as they can but with having to pay the money upfront now, even though it's not much, you've got to have that money there."

The rising cost of living has made things harder.

"I got the pension this morning, but when you've paid all the bills you've got $150 for the whole fortnight. Even when you get your medications, you get subsidised, but you've got to have that bit of money. When you're strapped for cash, even 5c is a fair bit."

Joe's doctor told him at his most recent visit that he would cease bulk billing as of 1 August.

"I informed him that due to financial constraints, I will now have to limit my visits no matter what the outcome," he says. "My house bills need to come first, then food comes second, and doctors will have to come third.

"I've cut my gas and electricity usage as far as you can - I can't cut that any lower, the only way I can cut it lower is by turning off the fridge - and I have been spending a lot of time in my man-cave with the log fire going. My doctor was concerned because the wood fire's doing me no good, but I said, well, I've got to stay warm."

Jade Bryan, who moved to the Queensland town of Gladstone a year ago, has tried to get an appointment at multiple bulk-billing clinics locally. Every time, she says, she has been told they are not taking any new patients.

Bryan most commonly interacts with the medical system to manage a mental illness. She's also trans, so she requires regular prescriptions for her hormone therapy. She is currently receiving jobseeker due to a disability that has rendered her unable to work. She says she ought to be seeing a doctor for her sleep apnoea, but she can't afford it, and so has tried to manage it herself.

She says she is lucky her previous doctor in Hervey Bay has agreed to continue bulk billing her for telehealth appointments, but says she has had scares, usually around refilling her scripts.

"There was a time when I was out of my antidepressants, and fronted up to the hospital and they've only been able to give me three days' worth," Bryan says.

"If you're on jobseeker, you're treated as a third-class citizen these days."