Australia can choose to make essential health care free when people need it. The task is to fund services well, build the workforce and make access a public responsibility.
Universal public health should mean that someone who needs care can obtain it, regardless of income. Australia’s Medicare system provides important protection, but a Medicare card does not guarantee an affordable appointment nearby.
There is also progress worth recognising. Bulk billing has improved under recent reforms, and many prescription medicines now cost less. The question is how Australia can build on those gains and close the gaps that still leave people waiting or going without.
Quick Answer
Australia can expand publicly funded health care and remove charges for a defined range of essential services. Medicare already covers public hospital treatment for eligible public patients and subsidises many medical services. Recent reforms have improved bulk billing, but fees, waiting times and gaps in coverage remain. The Commonwealth’s position as issuer of the Australian dollar gives it greater financial capacity than a household or state government. Lasting reform also needs enough trained staff, facilities and medicines. Social Justice Australia supports universal access based on clinical need, backed by workforce investment, accountable funding and a planned shift towards stronger public provision.
What universal public health should provide
The goal should be timely, clinically appropriate care without financial hardship. In this article, universal public health means universal access to health services. Public health also has a narrower professional meaning, covering work such as disease prevention and health protection.
Services Australia explains Medicare’s coverage. Eligible patients receive treatment without charges as public patients in public hospitals. Outside hospital, Medicare pays benefits towards listed medical services. Doctors may charge more than those benefits, leaving patients with a gap fee.
Most dental services sit outside Medicare. Public funding also does not automatically cover every allied-health visit or every mental-health appointment a person might need.
These are choices about the scope and design of public provision. They can be changed through legislation, funding agreements and service delivery.
Universal access also need not mean identical services everywhere. A remote community may need visiting specialists, supported transport and a well-resourced local clinic. A city suburb may need more appointments outside working hours. Equal respect requires services that respond to different needs.
Bulk billing has improved but access remains uneven
When a health professional bulk bills, they accept the Medicare benefit as full payment for that service. The patient pays no gap for it. A visit involving several services can still include separate charges for services that are not bulk billed, as Services Australia’s bulk billing guide explains.
The Department of Health’s April–June 2026 snapshot reports that 84.1% of GP non-referred attendances were bulk billed. This was 4.9 percentage points higher than in the same quarter of 2025.
The newer evidence shows a substantial recovery in bulk billing, although important gaps remain.
However, a service rate does not tell us how many people avoid fees throughout the year. The department’s 2025–26 patient dashboard reports that 54.5% of GP patients were bulk billed for every GP non-referred attendance, up from 49.1% the previous year. These figures exclude temporary COVID-19 vaccination items.
Someone with nine bulk-billed services and one privately billed service counts as usually bulk billed, rather than always bulk billed. This helps explain why a high service rate can coexist with many people still encountering charges.
The dashboard also shows a local divide. In Brisbane North, 40.0% of GP patients were always bulk billed in 2025–26, compared with 52.7% in Brisbane South, excluding COVID-19 vaccination items.
These annual patient figures and the quarterly service rate cover different periods and measures. Neither tells us whether every person who needed an appointment could obtain one.
The people who still postpone care
The Australian Bureau of Statistics Patient Experiences survey for 2024–25 found that 7.7% of people aged 15 and over delayed or did not see a GP when needed because of cost. This was lower than 8.8% in 2023–24.
Cost also led 16.1% to delay or forgo dental care. For prescription medicines, the figure was 7.5%. The survey covers usual residents of private dwellings aged 15 and over, so it does not represent every Australian.
These findings predate the November 2025 bulk billing expansion and January 2026 medicine changes. They establish the earlier scale of unmet need; they cannot measure those later reforms’ full effects.
For someone managing several conditions, affordability involves the whole course of care. A bulk-billed GP appointment can lead to a specialist fee, travel costs and further treatment expenses. A person may also lose wages while attending appointments.
A useful test of reform is therefore whether people complete the care they need. Counting subsidised appointments alone cannot answer that question.
What recent Medicare and medicine reforms changed
From 1 November 2025, eligibility for GP bulk billing incentives expanded to all Medicare-eligible patients. Previously, these incentives were limited to children under 16 and Commonwealth concession card holders.
The Bulk Billing Practice Incentive Program also began on that date. Participating practices receive an additional payment calculated at 12.5% of Medicare benefits for eligible services, shared equally between the practice and GP. Participation requires bulk billing of the program’s eligible services.
The improvement in service rates is consistent with the intended direction of these reforms. The figures alone do not establish how much of the increase was caused by each measure. Evaluation should examine appointment supply, patient charges and differences between communities.
Medicine costs have changed too. Since 1 January 2026, the standard maximum patient co-payment for a Pharmaceutical Benefits Scheme prescription has been $25, down from $31.60. The concessional co-payment remains $7.70. Applicable premiums can be additional, and some medicines cost less than the maximum.
The department’s explanation of PBS co-payments makes these limits clear. Lower charges provide practical relief. They also leave a policy question about whether essential medicines should carry patient charges at all.
Recognising improvements strengthens the case for reform. Public policy can change what patients pay.
Private provision and the use of public money
Public funding and public ownership are different questions. A government can pay an independent provider to deliver care without charging the patient. Bulk billing itself shows why paying a private provider is not automatically evidence of poor value.
The key questions concern access, quality, cost and accountability. Does the payment secure a useful service? Can patients obtain it without hardship? Are providers required to report results?
Any claim about the total public subsidy for private health care needs a clearly defined measure. Private insurance rebates, Medicare payments for private treatment and tax concessions are distinct forms of support. They should not be combined without explaining the boundaries and avoiding double counting.
The Australian Institute of Health and Welfare’s latest expenditure report puts private health insurance premium rebates counted as health expenditure at $7.2 billion in 2024–25. Its estimate excludes non-health costs such as insurance advertising, so it is lower than the total premium rebate reported under other accounting measures.
Social Justice Australia supports phasing out private insurance subsidies while expanding public capacity. That is an editorial position about priorities. Implementation should include an independent assessment of patient demand, staffing and treatment capacity.
An abrupt withdrawal without replacement services could shift more demand towards already stretched public facilities. A responsible transition would set out where patients will receive care and who will provide it.
The wider argument about market-led policy is explored in SJA’s article on neoliberalism in Australia. For health policy, that argument should lead to scrutiny of specific funding rules and outcomes, rather than assumptions about every provider’s motives.
How Australia can fund universal public health
The Commonwealth has greater financial capacity than a household. Australia issues its own currency, allows its exchange rate to float and issues government debt in Australian dollars. The Reserve Bank’s The Road to Australian Dollar Funding explains the importance of domestic-currency funding and the floating dollar.
State and territory governments, which operate public hospitals, do not issue the Australian dollar. A serious national health plan must therefore include reliable Commonwealth funding and workable agreements with them.
Modern Monetary Theory places particular emphasis on the Commonwealth’s currency-issuing capacity. Economist Bill Mitchell’s analysis of health funding sets out this argument. In that framework, the central question is whether spending can secure the workers and resources needed without generating excessive inflation. This is a contested economic framework, rather than a statement that every economist shares its policy conclusions.
Current operating arrangements also matter. The RBA’s About Monetary Policy explains that government deficits are funded through securities issued to the private sector under the Treasury–RBA arrangements. Parliamentary spending authority and debt management remain part of how government operates.
Taxes help manage demand and influence the distribution of income and resources. Interest costs, exchange-rate pressures and inflation also require attention. Monetary sovereignty gives Australia choices; it does not make all spending harmless.
For health care, those choices should start with a practical assessment. How many clinicians and clinics are needed? Which areas have unused capacity? What training and equipment will expansion require?
If a clinic has spare appointments, public funding may quickly make them affordable. If a town lacks a doctor, higher payments alone may fail to create immediate access. Training, recruitment and retention must accompany the funding.
Readers can explore these issues through SJA’s monetary sovereignty resources.
A practical programme for universal access
Social Justice Australia advocates a staged guarantee of essential care based on clinical need. The following priorities would connect that goal to delivery.
Make affordable primary care dependable
Assess GP payments against the cost of providing safe care, including longer consultations and treatment of complex conditions. Link additional support to clear access and reporting requirements.
Establish or expand public and community clinics where existing services cannot meet need. Offer secure roles, suitable facilities and support for clinicians to remain in underserved communities.
Fund teams that include nurses, allied-health professionals and administrative support, with clear clinical responsibilities. Patients should receive coordinated care rather than carry the burden of navigating each service themselves.
Extend the services that patients can obtain
Develop a staged national plan for essential dental care and more accessible mental-health treatment. Publish the workforce, infrastructure and funding required at each stage.
Work towards removing patient charges for essential PBS medicines. Define the covered medicines through evidence-based assessment and monitor supply, prescribing quality and patient access.
Expand rural services alongside transport, accommodation and appropriate telehealth support. Fund Aboriginal community controlled health services to design and deliver care with their communities.
The AIHW’s health workforce report describes the continuing access difficulties in rural and remote Australia. A national entitlement must come with a plan for people whose nearest suitable service is far away.
Make governments answerable for access
Publish local measures of waiting times, gap fees, patients unable to find a service and continuity of care. Report differences by income, disability, age and location where reliable data allow.
Review private insurance subsidies transparently and phase changes alongside additional public treatment capacity. Publish the expected effects and compare them with actual results.
Universal access can coexist with extra support for people facing greater barriers. Removing means tests from core entitlements should not prevent targeted assistance for travel, disability or other additional needs.
A stronger public guarantee is achievable
Australia already demonstrates that government can fund care without charging patients at the point of treatment. Recent improvements in bulk billing and medicine costs show that funding decisions matter.
The remaining gaps require sustained public investment and service planning. Ending patient charges for essential care is a policy goal Australia can pursue. Achieving timely access also requires trained people, reliable supply and institutions that deliver what funding promises.
Social Justice Australia’s position is that essential treatment should be available according to need. Governments should publish a credible route towards that goal and be judged by patients’ ability to obtain care.
Frequently Asked Questions
Is Medicare already universal
Medicare is Australia’s universal health insurance system for eligible people. It does not cover every service or guarantee that every provider will bulk bill. Coverage, affordability and timely access are separate questions.
Does bulk billing mean everything in a visit is free
No. Bulk billing removes the patient charge for the particular service bulk billed. A visit can involve other services or items with separate charges. Ask about the full cost when booking.
Can Australia make essential health care free
Government can fund a defined package without patient charges. Delivering it requires spending authority, suitable payment arrangements and enough staff, facilities and supplies. Broader public funding is feasible as a policy direction; the pace depends on capacity.
Would ending insurance subsidies immediately fix hospitals
No. Changing subsidies does not automatically create additional nurses, operating theatres or specialist hours. A transition needs to account for changes in patient demand and expand public capacity accordingly.
What can citizens ask governments to do
Ask for local access targets, transparent fees and waiting-time data, and a funded workforce plan. Raise specific service gaps with federal and state representatives and contribute to relevant public consultations.
Share your experience and support the discussion
What changes would make the greatest difference to obtaining care in your community, and how should governments measure success?
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Authoritative Sources
- Department of Health, Disability and Ageing — National GP Bulk Billing Snapshot – April to June 2026. 10 August 2026.
- Department of Health, Disability and Ageing — Medicare statistics – per patient bulk billing dashboard 2025–26. 10 August 2026.
- Australian Bureau of Statistics — Patient Experiences, 2024–25 financial year. 18 November 2025.
- Services Australia — Health care and Medicare. accessed 5 November 2026.
- Services Australia — Bulk billing. updated 1 July 2026.
- Department of Health, Disability and Ageing — Bulk Billing Practice Incentive Program registration now open. 1 November 2025.
- Department of Health, Disability and Ageing — PBS co-payments. accessed 5 November 2026.
- Australian Institute of Health and Welfare — Health expenditure Australia 2024–25 — Government sources: Australian government spending. updated 14 October 2026.
- Reserve Bank of Australia — The Road to Australian Dollar Funding. Bulletin, March 2020.
- Reserve Bank of Australia — About Monetary Policy. accessed 5 November 2026.
- Australian Institute of Health and Welfare — Health workforce. accessed 5 November 2026.
- William Mitchell — A government can always afford high-quality health care provision. 18 July 2017.
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