Bulk billing is back, but at what cost to GP businesses?

Access improves, but pressure builds

Bulk billing is back. But for many GP clinics, the question is whether they can afford it.

New data from the Cleanbill January 2026 Blue Report shows the proportion of clinics fully bulk billing standard weekday GP consultations for all adult patients has risen from around 21% in 2025 to approximately 40% in 2026 (Cleanbill, 2026). More than 1,000 clinics have shifted from mixed or private billing models back to full bulk billing over the past year.

For patients, the shift represents improved access to care. For general practices, the picture is more complex.

What’s driving the shift back to bulk billing

The rebound has coincided with expanded federal bulk-billing incentives introduced in late 2025, alongside rising cost-of-living pressures and growing patient sensitivity to out-of-pocket fees.

Competition between practices is also playing a role, particularly in areas where patients are actively seeking fully bulk-billed services.

Dr Michael Wright, President of the Royal Australian College of General Practitioners, says the incentives are having a measurable impact, particularly in regional areas.

“The new incentives introduced on 1 November have increased support for GPs and their patients and particularly targeted those in regional and rural Australia, where the incentives are greatest. That is no doubt leading to the increased availability of bulk billing, particularly in those regions.”

However, he cautions that the policy settings are not universally effective.

“The Department of Health’s own modelling shows they won’t work for all practices, and we are seeing that already.”

Does bulk billing still stack up as a business model?

Despite the increase in bulk billing rates, concerns about financial sustainability remain.

According to the Cleanbill Blue Report, average out-of-pocket costs at non-bulk-billing clinics have continued to rise, reaching around $49 nationally. This reflects the ongoing gap between Medicare rebates and the real cost of delivering care.

Dr Wright says the pressure is being felt most acutely in longer and more complex consultations.

“The costs of providing care have risen much more quickly than Medicare rebates, which were frozen for nearly a decade. That has placed a lot of increased pressure on practices.”

He also highlights a structural issue within the rebate system itself.

“Patient Medicare rebates drop on a per-minute basis the longer a patient spends with their GP, making it harder for patients who need more time with their GP to access affordable, high-quality care.”

For practices, this creates a fundamental tension.

Bulk billing may improve patient access, but it can reduce revenue per consultation, placing pressure on staffing, appointment lengths and overall service delivery.

In this context, bulk billing is not simply a pricing decision. It is a structural one.

Conflicting signals in the data

The interpretation of bulk billing trends is not straightforward.

Reporting by the ABC, based on Cleanbill data, highlights a significant rise in fully bulk-billing clinics. However, federal government commentary has questioned the reliability of the findings, pointing to limitations in methodology and alternative indicators such as MyMedicare registrations and Medicare claims data.

At the same time, official figures indicate that thousands of practices have moved towards bulk billing under new incentives, suggesting that the broader trend is real, even if the scale is debated.

For healthcare leaders, this creates uncertainty.

The data signals improved access, but it does not resolve the underlying question of sustainability.

A strategic decision for GP businesses

For GP clinic owners and operators, the return to bulk billing is no longer just a response to policy.

It is a strategic decision with long-term implications.

Practices must balance:

• Patient demand for affordable care 
• Rising operational costs 
• Workforce pressures 
• The need for financial viability 

Dr Wright says the long-term risk is that access gains may not be sustainable without broader reform.

“All Australians deserve affordable access to GP services, and we know that consults are getting longer and care is getting more complex.”

He points to the need for further investment, particularly in longer consultations.

“The RACGP has long called for a 40% increase to Medicare rebates for Level C and Level D consultations.”

Some clinics may find bulk billing viable under current incentives, particularly in high-volume settings. Others may continue to rely on mixed billing models to remain sustainable.

There is no one-size-fits-all approach.

The bigger question for primary care

The rebound in bulk billing highlights a deeper structural issue within Australia’s primary care system.

Access and sustainability are increasingly in tension.

Improving one can place pressure on the other.

For healthcare leaders, the challenge is not simply to respond to policy changes, but to build models of care that can withstand ongoing shifts in funding, demand and workforce dynamics.

Bulk billing may be back. But whether it is sustainable remains an open question.