Access and affordability of primary care is currently a major focus of health politics. Bulk-billing rates for GPs have now fallen to around 65%, from a high of about 80% in 1997. A range of factors, including the supply of GPs, changing consumer expectations, shifts in practice patterns, increasing costs and declining relative incomes have probably contributed to the fall in bulk billing. As bulk-billing rates fall, out-of-pocket costs for patients go up and affordability and access to services is reduced, at least for people on lower incomes. Access and affordability are particular problems for people in rural areas where bulk-billing rates are generally 10% to 20% below those in metropolitan areas.