Members Health Fund Alliance, an advocacy group for not-for-profit health insurers in Australia, has called for the federal government to lift restrictions preventing health funds from covering general practitioner (GP) out-of-pocket costs.
The organisation argued that the prohibition – which allows insurers to cover services such as dental, optical, and physiotherapy but not GP visits – is outdated and out of step with current healthcare needs.
Members Health CEO Matthew Koce explained that removing the restriction would make GP visits more accessible, improve health outcomes, and alleviate cost-of-living pressures for many Australians.
“It makes no sense that health insurance funds can help cover the cost of dental, optical, and physio appointments but not something as important as a trip to the GP,” he said.
New data analysed by Money.com.au revealed that Australians with private hospital insurance are facing significantly higher out-of-pocket costs, which have surged by 71% over the past five years. These gap payments – expenses not covered by Medicare or private insurance – have outpaced the growth in other healthcare costs.
Between 2019 and 2024, the average gap payment for disclosed costs increased from $99 to $135, while undisclosed costs rose from $418 to $685. In comparison, hospital service costs increased by 22%, Medicare rebates by 18%, and private insurer contributions by just 12%. Health insurance premiums have also risen by 15.1% during this period, further straining household budgets.
Citing the Cleanbill Report from January 2025, Members Health highlighted the financial strain on patients, who pay an average of $43.38 per GP visit. In some areas, fees exceed $50 per consultation.
Koce said the cost-of-living crisis sees many Australians avoid trips to their GP due to expense, leading to worse health outcomes and higher long-term costs for the system. He underscored the role GPs play in maintaining public health, warning that deferring visits due to costs can result in preventable medical complications and chronic disease mismanagement.
“GPs underpin the health system. They are fundamental to good population health. Putting off a trip to the GP due to expensive out-of-pocket costs can have very serious consequences. It can result in avoidable medical complications, poorer chronic disease management, more severe and prolonged illness, shorter life expectancy, and much worse long term health outcomes,” he said.
With the 2025 federal election approaching, Members Health is calling on political parties to prioritise policies that address escalating healthcare costs, including out-of-pocket expenses for GP visits.