The average out-of-pocket cost to see a general practitioner in Canberra has doubled over the past decade, from $19.10 to $40.38, despite bulk-billing rates in the national capital rising just over 6 per cent across that period.
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Medicare figures recently released for the September quarter of this year show the ACT's bulk billing rate hit 56 per cent, just 6.3 per cent above that recorded in the December quarter 2006.
That 6.3 per cent rise in bulk billing rates in Canberra was comparable to 10-year increases in other jurisdictions, except the Northern Territory, where the rate rose a remarkable 26.3 per cent, from 60.8 per cent to 87.5 per cent, over the same period.
But the ACT remains the jurisdiction with the lowest long-term bulk billing rate in the country, some 27.1 per cent lower than the national average.
Doctors argue the increasing costs of running surgeries, set against a backdrop of a freeze on Medicare rebates in the past few years, has meant many Canberra GPs have been unable to increase bulk billing to more people
Australian Medical Association ACT president Dr Steve Robson said while rebates had been frozen, doctors had faced rising costs, from rent and rates through to insurance premiums and staff wages.
Dr Robson said Canberra doctors had a choice between seeing more patients for less time, and bulk billing some of those, or spending more time with fewer patients, but charging them the out-of-pocket expense.
He said the entry of "large corporate" practices had also affected smaller family-oriented GPs, with larger firms capitalising on bulk billing to see more people with minor ailments like common colds, a move he said was leaving smaller practices with longer, more expensive appointments for patients with multiple chronic conditions.
"I think there's a community obsession with bulk billing, it's really important that healthcare be provided, but at the end of the day, bulk billing itself does not equate to health outcomes and they shouldn't be used as a measure of the quality of care a patient receives," he said.
But Grattan Institute health policy director Dr Stephen Duckett said the freeze was only introduced by Federal Labor in 2013 and it did not explain the rising costs people were paying in Canberra and entrenched pattern of low bulk billing in the Territory.
"The doctors in the ACT have never been bulk billing at the same rate as doctors in other metropolitan centres," he said.
"It's just the peculiar mix of doctors who decided to set up in Canberra; this is a pattern that's gone on for more than 30 years, and it's pleasing it has gone up in the past 10 years, but it still has a long way to go before people will be able to get reasonable access."
Dr Duckett said part of the explanation for low bulk billing rates in the ACT was the higher average income of residents, but the rebate freezes "do not explain the differences compared to other states, it's not an adequate explanation".
He said he believed Canberra's doctors were "ideologically opposed" to bulk billing and when it came to the $20 rise in "out-of-pocket" patient contributions for GP appointments, doctors were pocketing the money.
But he said while the Medicare rebate freeze would have an impact on GPs incomes, "we can't see an impact yet" as doctors had absorbed the costs, but that "doctors are going to have to move towards [full] billing" as the freeze started having a greater effect.
The AMA recently urged all its members nationally to start charging an additional $2 co-payment for appointments, to make up for the impact of the rebate increase freeze.
But Dr Robson said he was not aware of any Canberra doctors who had begun charging the extra fee and most GPs tried to offer bulk billing where possible.
"You'll find most practices in town will be selective [when bulk billing], they'll know people who can afford to pay, and those with chronic illnesses or disadvantaged people who can't and they won't charge people if they can avoid it," he said.
"But at the end of the day, you've got to run a practice, you have to be able to afford to keep the doors open."
