When Richard and Julie Halloran stood at the reception desk of their local GP in south-west Sydney and were asked to pay a fee, it came as a shock.
The couple had been bulk-billed by their doctor for 25 years and could not afford to pay the gap.
“We have always mostly been bulk-billed,” Richard said.
“It’s hard, especially if you don’t have the cash on you that day.”
At their next appointment, their GP agreed to continue to bulk-bill them.
It was a huge relief for the couple who had multiple chronic health conditions and need up to eight medical appointments between them every month.
Julie, who suffers from epilepsy and high cholesterol, said without bulk-billing they would have to make hard choices.
“I know I would go to the doctor less, because I just couldn’t afford it,” she said.
“My epilepsy would suffer because I just couldn’t afford to go and see the doctor as well as pay for medication I’ve got to take.”
A new report shows the Hallorans are not alone in their anxiety.
A study which tracks wellbeing as perceived by the people who live in Greater Western Sydney shows access to quality healthcare is residents’ number one concern, ahead of security, housing and cost of living.
Access to healthcare greatest perceived threat in Greater Western Sydney
The study, commissioned by the Greater Western Sydney Leadership Dialogue, is modelled on the federal government’s Wellbeing Index Framework.
This week’s NSW state budget will be the first time a Wellbeing Index — which takes into account not only data about wellness, but also how people feel about their lives — will be used to help make funding decisions.
Dialogue CEO Adam Leto said the report, which has been dubbed a “wellbeing temperature check”, comes at a critical time for the region.
“For most people, I think it doesn’t matter how successful or how fine your life is or how pleasant your life is, if you’re not healthy, then none of the other stuff really matters,” he said.
The 609 respondents rated access to quality healthcare and services as their number one wellbeing concern, followed by safety, financial security, stable housing and access to good quality natural environments.
The survey found overall levels of life satisfaction were high, with almost all of those over 80 and 64 per cent of those aged 60 to 69 completely or mostly satisfied with their lives.
Young people did not rate their wellbeing so highly, with only half of 18 to 29-year-olds reporting strong feelings of hope, belonging and satisfaction.
Doctors already hard to access
In Campbelltown, the Hallorans’s GP Dr Ken McCroary said the couple was one of many patients who were increasingly stressed about accessing affordable healthcare.
“I’m seeing this all the time, every day … people struggling to get access to the general practitioners,” he said.
“I have these people like the young guy, a tradie with diabetes that can’t afford his insulin, or the beauty therapist with multiple sclerosis … all these people that can’t afford medicines and visits.
“Something has to give, and it’s their health, and that is really sad.”
He said while many doctors wanted to bulk bill, the increasing cost of running a practice without charging a gap is untenable.
“We’re seeing practices close all the time,” he said.
“Just in my region alone, we’ve had 30 practices close in the last year, which is way, way too many practices.”
The Australian Medical Association NSW estimates one GP clinic closes every 40 days in south-west Sydney based on data collected from Local Health Districts.
Data is not collected on the number of new clinics that opened, or the availability of bulk-billing services.
Dr McCroary said the closure of practices meant preventable illnesses were left untreated.
He frequently treated patients for diseases and deficiencies, including diabetes and kidney failure.
“I treated a woman recently for scurvy … Captain Cook sorted that out 250 years ago,” he said.
“But if you can’t afford fruit and vegetables, you’re going to get all these preventable health conditions.”
(ABC News: Holly Tregenza)
Hospitals under pressure
Dr McCroary said patients who cannot afford to pay a fee are inevitably turning to the hospital system, which is already under stress.
A report from the South-West Sydney Local Health District (SWSLHD) outlining the regions key challenges found hospitalisation rates for diabetes in the area are the highest in metropolitan Sydney.
Hospitals in SWSLHD are also more likely to treat patients for health issues which could have been prevented than their central Sydney counterparts.
The proportion of patients accessing bulk-billing is higher in south-western Sydney than in any other part of the state, at a rate of 93.7 per cent.
No data exists to quantify how many bulk-billed appointments are available, largely because doctors can waive the fee at their discretion.
Mr Leto said access to primary health providers was a critical part of easing healthcare anxiety in the region.
“It’s accessibility, it’s availability, and it’s affordability,” he said.
“People need to be able to afford go into a GP, they need to have access to one that’s locally based and convenient, and they need to be able to have enough GPs to service the ongoing needs.”
As the Hallorans get older, they worry about their reliance on Dr McCroary’s ability to wave a co-pay fee, as well as when he decides to move on.
“He’s a very good person to have as your GP, and we would hate to lose that,” Mr Halloran said.
“Everyone retires eventually … it would certainly concern us if we didn’t have that access anymore.”
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