Patients are being asked to make an additional, separate transaction at general practices across Adelaide of between $5 and $10 to cover increased operating costs following the implementation of payroll tax for contracted doctors in 2024.
An increasing number of private general practices in South Australia are introducing new "administration fees" to cover rising operating costs, blaming payroll tax changes for the additional cost to patients.
The levy is typically $5 to $10 and is billed as a separate transaction to consult fees in mixed billing or private billing practices. One mixed billing practice wrote on its website that it had no choice but to introduce a "$5 administration levy on all private consultations" after trying to absorb the costs of "government-mandated payroll tax changes". A group with more than a dozen practices across Greater Adelaide is charging a $6.60 admin fee in response to the payroll tax, which it said online followed an "incorrect and inappropriate classification of the relationship a practice has with a practitioner". Another health care provider in Adelaide's East also said it had lifted its fees in response to rising operational costs, but singled out the SA government's payroll tax as being a key factor, despite their doctors operating with "significant independence".for medical practitioners began in 2023 following a NSW Supreme Court ruling finding that payments to contracted professionals under the standard service fee were taxable as wages.One in two Australians missed out on health care they needed last year mainly because they could not afford it, according to a new report by the peak healthcare consumers group. SA Treasurer Tom Koutsantonis gave the state's health care providers an amnesty for paying payroll tax relating to contracted GPs, medical specialists and dentists in 2023, and made them retrospectively exempt for undeclared wages from July 1, 2019 to June 30, 2024. But they had to be registered for payroll tax from July 1 2024, after which any exemption to payroll tax ended. The changes followed what the state government described as a past "lack of awareness or misinterpretation" about GP tax obligations under the Payroll Tax Act 2009.Australian Medical Association SA president Peter Subramaniam said general practices were being hit with rising costs like all businesses, but if they could not absorb them it could result in barriers to primary health care. "A patient who doesn't go and see the doctor or the paediatrist or the allied health person because of what appears to be a small increase to out-of-pocket costs — if they end up in hospital, that's a large downstream cost," he said. "If the cost creates a barrier to access, even if it's a small barrier, the downstream costs for the system is disproportionately large." Dr Subramaniam said a person presenting at a hospital's emergency department would cost "many more times what it costs for a single GP consultation".Like SA, Victoria has made similar exemptions for those that bulk-billed, but in Queensland the government made all GPs, regardless of whether they bulk-billed or not, permanently exempt. "At the time it was a closely contested election and both sides saw that they wanted to remove the distortion in general practices," Dr Subramaniam said.He said a complete exemption in SA would be a step — but "not the only step" — towards improving access to primary care for people in the community."That's not our argument. Our argument is about tax efficiency, about health system consequences and access for patients. "It's all about harm minimisation. We want to have a conversation with the government that's mature and evidence based." A state government spokesperson said SA had among "the lowest out-of-pocket costs to visit a GP in the country". "The payroll tax exemption is aimed both at protecting bulk-billing and supporting the sustainability of GP clinics," they said. "Data suggests more than two thirds of practices currently bulk-bill and are therefore eligible for this exemption." Royal Australian College of General Practitioners SA chair Siân Goodson said the body did not have figures for GPs charging administration fees, but was aware they had been implementing it to cover additional costs "and growing complexity of running a practice, including payroll tax, in order to remain viable".The healthcare provider with multiple practices across Greater Adelaide said online its fee was also due to rising operational costs such as rent, staff wages, information technology, insurance, rates and electricity, blaming the federal government for failing to fully index Medicare for the past 12 years.Services Australia is urging people to check if they're owed money from a $272 million pool of unclaimed money."While bulk-billing incentives have increased bulk-billing, especially in rural areas where the incentives are greatest, the federal department of health's own modelling shows bulk-billing incentives don't cover the cost of care for all practices. "We are advocating for increased Medicare rebates, especially for longer consults, to reduce out-of-pocket costs for our patients." In November last year, the federal government invested $8.5 billion into Medicare in an effort to boost the number of fully bulk-billed practices nationwide to 4,800 by 2030, or what it said would be triple the number available in February 2025.Just In
AMA RACGP Peter Subramaniam Tom Koutsantonis Bulk Billing Exemption Australian Medical Association
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