The average out-of-pocket cost for West Australians unable to see a bulk-billing doctor has hit almost $41, eclipsing the national standard and the Medicare rebate, as new data shows just one-in-four clinics offer subsidised services. The new Health of the Nation report by online healthcare directory Cleanbill found 26.6 per cent of GP clinics statewide bulk-bill, well below the waning national average of 31.5 per cent.