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A Visit To The GP Is Costing More Each Year, Especially For Those With Anxiety and Depression

Aussies are visiting their GP for mental health issues more than any other physical illness, and they're being disadvantaged by lower Medicare rebates. 

These are the main findings  from this year's 'Health of the Nation' report that calls on government action on mental health, obesity and Medicare, as GPs struggle to deliver adequate care for complex illness.

The Royal Australian College of General Practitioners (RACGP) report, launched in federal parliament on Thursday, surveyed 1,200 college members across the country.

About 65 percent of GPs reported psychological issues -- including depression, mood disorders and anxiety -- as being the most common ailment they treated. This was up from 61 percent in 2017, the first year the report was tabled.

Photo: Getty

Musculoskeletal and respiratory problems, including asthma and the common cold, came in second and third (40 percent and 39 percent respectively).

Male GPs were more likely to report managing musculoskeletal and respiratory issues, while female GPs managed mental health problems.

This is not only the most common experience of patients, with almost one in 10 GPs reporting delaying their own mental health care due to concerns about being reported to regulatory bodies.

READ MORE: Gillard: 'I Wish I Understood More' About Mental Health As PM 

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More widely, GPs reported struggling to provide adequate mental health care to meet the increased demand due to the structure of the Medicare system.

President of the RACGP, Dr Harry Nespolon, said current structures tend to support shorter consults over those who needed to manage more complex health issues.

“Patient care related to Australia’s leading health issues -- chronic disease, mental health and obesity -- is complex and often requires more time than a standard consultation allows," he said. 

According to the report, Medicare Benefits Schedule (MBS) rebates are also lower than those for physical illness.

For example, a standard physical consult of between 20 and 40 minutes attracts a rebate of $73.95, whereas the rebate for a mental health consultation over 20 minutes is $72.95. This excludes appointments to prepare for a review mental health care plans.

In July, the federal government ended a freeze on the rebate for GP visits, indexing specialist procedures, allied health services and other services such as mental health and after hours.

Under the indexing process, the Medicare Benefits Schedule (MBS) -- which lists the services the government will pay a rebate for -- is raised according to the Department of Finance's Wage Cost Index, which combines wage levels and the Consumer Price Index (CPI).

But Nespolon said lower rebates for mental health consults have long been problematic, "despite the central role mental health plays in all GPs' clinical lives".

“While the federal government has made recent attempts to restore rebates through indexation, Medicare is still the number one issue of concern for GPs around the nation,” he said. 

The report also highlighted a growing gap between the Medicare rebate and the cost of providing care.

Rebates are typically paid as a percentage of the Medicare schedule fee, and don’t cover the full cost of medical services. 

GPs who bulk bill agree to charge the Medicare schedule free, and are reimbursed by the government. Those who don’t can set their own prices, and in these instances, patients pay, often leaving an  “out of pocket” cost. 

READ MORE: What A Labor Government Would Really Mean For the 'Medicare Freeze'

According to the report, bulk billing may not be as high as suggested by Medicare statistics -- or the Federal Health Minister Greg Hunt. 

"Medicare statistics indicate that 86.2 percent of general practice services were bulk billed in 2018-19," the report said.

"While this figure provides an indication of total bulk-billed services in Australia over this period, it does not represent the number of patients who are bulk billed, nor does it represent the number of patients who are bulk billed for all of their general practice care."

While the number of GP services being bulk billed is increasing, the report said that rate of increase is slower than ever.

For the first time, it found a decline in the proportion of bulk-billed services outside major cities -- affecting the seven million Aussies living in regional, rural are remote areas.

Meanwhile, out-of-pocket costs paid by patients continue to increase each year.

While varying across the country, the average cost was $38.46 in 2018-19, which is higher than the medicare rebate for the most commonly used GP item.

Featured image: Getty