Did falling bulk billing push people to emergency departments?
A common claim is that when GP visits cost more, people go to hospital emergency departments instead. Comparing Medicare and hospital data for 2017–18 to 2024–25, there is no link the data can detect.
Nationally, emergency use didn’t rise
Between 2021–22 and 2023–24, the share of GP visits bulk billed fell from 88.3% to 77.3%. Lower-urgency emergency presentations, the kind that could often be seen by a GP, did not rise. COVID-19 pushed them up in 2020–21 and 2021–22, but by 2023–24 they were at 110.1 per 1,000 people, below the 120.0 of 2018–19, before the pandemic, and they fell again to 104.7 in 2024–25.
If dearer GP visits were sending people to hospital, emergency use should have risen as bulk billing fell. It didn’t.
Figure 1.Share of GP visits bulk billed, Australia
Figure 2.Lower-urgency emergency presentations per 1,000 people, Australia
Financial years ending in June. Emergency rates are age-standardised and counted by where people live. Sources: Medicare quarterly statistics, state and territory; AIHW, Use of emergency departments for lower urgency care 2017–18 to 2024–25.
Area by area, no pattern either
A national total can hide local effects, so the stronger test compares each area with itself. If falling bulk billing pushed people to emergency departments, the areas where it fell most should show the biggest rises.
Across 185 city areas, they don’t. Bulk billing fell between 2021–22 and 2023–24. Emergency use is measured from 2018–19, because COVID-19 inflated it in some areas in the years between. The correlation between the two changes is −0.07, and −0.03 when each area is compared only with others in the same state and of the same type. Zero means no link. Allowing for chance, the 95% ranges are −0.21 to +0.08 and −0.18 to +0.12: both include zero, and neither leaves room for more than a weak link either way.
In the latest year there is a hint the other way: areas where bulk billing rose more saw emergency use fall more (correlation −0.38). But it rests on about 10 unusual areas and disappears without them (−0.08), so it isn’t evidence either way.
Figure 3.Change in bulk billing (2021–22 to 2023–24) and in lower-urgency emergency presentations (2018–19 to 2023–24), city areas
Each dot is one local area in a major city. Regional and remote areas are left out because the AIHW counts only formal emergency departments there, which makes them hard to compare. Sources: Medicare quarterly statistics, SA3 summary; AIHW.
What this does and doesn’t show
It shows that, across areas and years, falling bulk billing did not come with a measurable rise in lower-urgency emergency visits. It does not show that cost never sends anyone to hospital. Several things were moving at once:
- COVID-19 distorted emergency use in 2020–21 and 2021–22.
- Medicare Urgent Care Clinics began opening in mid-2023 and took some lower-urgency patients away from emergency departments.
- Area averages can hide individual people who did go to hospital instead.
- “Lower urgency” is not the same as “could have seen a GP”. A 2023 study in the Medical Journal of Australia found many of these patients needed tests or treatment a general practice couldn’t provide.
So the honest conclusion is narrow: if falling bulk billing pushed people into emergency departments, the effect was too small to see in these data.
Further reading: AIHW, Use of emergency departments for lower urgency care; Lower urgency care in the emergency department and suitability for general practice care, MJA 2023.