Is cost a barrier to general practice for Australians with mental illness?

Cost is a barrier to access to general practice care in Australia.¹ Clients of mental health services face a physical health burden that exceeds that of the general population and so have a greater need for primary health care services.^2,3 Cost is a barrier to primary care for this population.

The Eastern Suburbs Mental Health Service (ESMHS), a tertiary mental health service in inner metropolitan Sydney, facilitates access to general practice (GP) care for its clients to mitigate their physical health risk. The service has 574 clients. The service experienced increased difficulty accessing GP services for clients in 2023, thought to be due to a fall in bulk-billing rates and associated rising costs for general practice care, a view reflected in the local media.⁴ The overall rate bulk billing for New South Wales (NSW) was 82.3%.⁵

An audit of ESMHS clients was conducted to assess the extent to which cost was a barrier to client access to GP care. Case managers were asked to survey their clients about whether their GP bulk-billed them and cost was a barrier to access.

Responses were obtained from 123 clients (21.4% of the total). Results are shown in Table 1. Overall, 87% of respondents were bulk-billed and cost was an issue for 32%.

Clients of tertiary mental health services are likely to be among the most mentally ill Australians. Clients who did not provide responses may be particularly disorganised and so challenged to access general practice.

The cost of accessing general practice was an issue for a minority of respondents, and bulk-billed services were widely accessed, more than for the general NSW population. These results do not support a hypothesis that cost is a barrier to access to general practice by clients of ESMHS.