Canberra's bulk-billing problem should be easy to solve

Or rather, it has once again raised the vexed question of why so few doctors in Canberra offer bulk-billing services.

While most Canberrans are used to it, it's a matter of enduring frustration, especially for the many newcomers who join the large transient contingent of the city's population.

The National Health Co-op was established about 15 years ago to directly address the lack of available bulk-billing GPs. It received some start-up funding from the ACT and federal governments, and now has eight locations across the ACT.

But with news of its potential closure, attributed to the end of JobKeeper and "recent staff changes", ACT Health Minister Rachel Stephen-Smith has called on the federal government to reconsider cutting off Canberra from bulk-billing incentives, as 30,000 Co-op members face an uncertain future.

She said the travails of the Co-op highlighted the difficulty to make a bulk-billing general practice "add up" in the ACT.

For any Canberran used to stumping up sometimes ridiculously large sums for a straightforward doctor's appointment, it is becoming increasingly difficult to even explain, much less justify, the lack of bulk-billing throughout the city.

The reasons, historically, have to do with Canberra's small population and low proportion of GPs throughout the city, but surely, with the city's growing population, these are causes that could have been addressed some time ago.

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Many Canberra doctors bulk-bill at their discretion, to those patients most in need, and the thinking is that this clears up any issues of inequality when it comes to access to health care. But equal access to healthcare should be a starting point, rather than a case-by-case approach to patients.

Ms Stephen-Smith said it's "not good enough" that the ACT lagged behind every other jurisdiction with bulk-billing options for residents.

"We have the lowest rate of bulk-billing of any capital city in the country, of any jurisdiction in the country," she said.

But the president of the Royal Australian College of General Practitioners, Karen Price, maintains that bulk-billing is not the answer, and broader reform of the system is needed.

This is hardly a revelation; the Australian healthcare system has long been an unwieldy patchwork of Bandaid solutions and out-of-date compromises. But Dr Price also points out that Medicare hadn't adapted to modern medicine practices and changing health needs.

In this context, Canberra is but one city, albeit one with a widening demographic, and its own changing needs.

It's puzzling that, of all things, affordable healthcare should be a seemingly insurmountable problem. But one of the advantages of a small population should be that a more progressive approach to primary healthcare from the ground up should be relatively easy to implement.

And, if all else fails, the ACT and federal governments could once again step in and help save what was, by all accounts, a reasonably good solution to Canberra's otherwise baffling bulk-billing issue.

It's hard to understand what the end point to this problem will be, if the solution apparently only lies in fixing and much larger, broken system.

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