Bulk billing is a payment option under the Medicare system of universal health insurance in Australia. It can cover a prescribed range of health services as listed in the Medicare Benefits Schedule, at the discretion of the health service provider. The health service provider - usually a doctor - is paid 85% of the scheduled fee for outpatient services; and 75% of the scheduled fee for inpatient services, by billing the government via the patient's Medicare card. The service provider receives a fixed proportion of the scheduled fee but avoids the costs and risks of billing and debt collection. It could be described as a form of factoring. Bulk billing rebates may be collected and paid directly to the service provider, or the service provider may collect the equivalent fee from the patient; leaving the patient to claim the rebate online, over the telephone, by mail, or at a Medicare office. Increasingly, service providers offer electronic lodgement at the practice using EFTPOS. Under Medicare, it is not permissible to charge the patient a co-payment with bulk billing (although this was previously permissible): a service provider who bulk bills for a service may not charge the patient further for that service. Decline in bulk billing Service providers may choose whether or not to use bulk billing. In January 2023, it was reported that only 42.7% of general practitioners bulk billed, while outside of Sydney and Melbourne less than a third bulk billed. In the Australian Capital Territory and Tasmania, only 5% and 6.9% of GPs bulk billed respectively. The key purpose of bulk billing is to provide an economic constraint on medical fees and charges. To address the decline in bulk billing, the Australian Medical Association (AMA) called on the federal government to revise indexation to ensure rebates better reflect the rising costs of providing medical care and running a practice, which it says would encourage more GPs to bulk-bill. The President of the AMA said that the "average government contribution to Medicare claims have fallen in real terms by more than 5 per cent over the past two decades, placing significant cost pressures on doctors 2014 co-payment proposal In the 2014 Australian federal budget, the Abbott Government proposed to impose a $7 co-payment for all bulk billed GP and medical test visits. The proposal was to reduce the medicare rebate payable to service providers by $5 (which applies to all