HUNTER residents are routinely being left $30 out of pocket for a 20-minute visit to a general practitioner as the Medicare rebate fails to keep pace with inflation.
A survey conducted by The Herald found only a handful of practices in the Hunter offered bulk-billing without restriction.
The most expensive practice was in Lake Macquarie charging $70 for a 20-minute appointment, others charged more than $100 for an initial consultation to allow time for a family history to be taken.
Most of the surgeries surveyed charged between $55 and $64 for a standard consultation.
The majority of surgeries bulk-billed children, pensioners and concession card- holders, while charging other patients.
The Government's schedule fee, which is paid to doctors for a 20-minute consultation, stands at $34.30, about $20 more than when Medicare started in 1984.
Anything a GP charges on top of that is the gap the patient pays.
Doctors who spoke to The Herald said they had no choice but to charge up-front fees to avoid going out of business or being overrun by patients.
The Australian Medical Association has warned that the number of free doctors will continue to dwindle in the Hunter because Medicare rebates were too low for businesses to remain viable.
AMA NSW president Brian Morton said gone were the days when bulk-billing was enough to run a business on.
Dr Morton said there was no doubt that bulk-billing was a "thing of the past" and unless the Government significantly changed its primary health-care delivery it would die out in the next five to 10 years.
He said it was impossible to provide quality patient care if "you go broke" and the Government was moving towards a "user-pays system".
"It's a very straight-forward issue, the rate paid to doctors does not adequately compensate for time and overheads," he said.
"General practices are unable to provide quality patient care on bulk-billing rates, they can only do it if there is a high through put of patients . . . the Government has got to change the patient rebate."
News earlier this year that Australia's largest medical centre operator, Primary Health Care Limited, which operates Charlestown's Primary Medical and Dental Centre, scrapped bulk-billing at 15 of its 84 centres sent alarm bells ringing throughout the medical fraternity.
Primary Health Care's managing director Edmund Bateman said patients at the Charlestown centre were still being bulk-billed, but warned of a "progressive decline" in bulk-billing over the coming years.
Dr Bateman described the situation as a "disgrace" and said the Government needed to double the rebate to keep pace with the increasing costs of running a medical practice.
"It is a matter of economics and you can't keep squeezing the lemon forever," he said. "The schedule fee goes up 1 per cent and inflation goes up 3 or 4 per cent and we lose . . . you can't keep providing charity to people forever."
The Charlestown centre has 16 doctors and two practice nurses and is open 365 days a year.
GP Access chief executive officer Mark Foster said just about every GP in the Hunter bulk-billed some patients.
"The proportion of services bulk-billed in the Hunter is about 70 per cent, sometimes consultations are bulk-billed but the procedure won't be," he said.
Beresfield doctor and former chief executive of the Urban Division of General Practice Arn Sprogis said that there was no benefit for the doctors to publicise the fact if they still bulk-billed their patients, as they would be fearful of attracting more business.
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