Bulk billing fails them most in needs By Kay Barney Bulk billing for medical consultations seems to be failing those most in need of health care, with better educated people and those without substantial health problems getting the greatest advantage from the system, a report co-authored by an ANU researcher has said. Dr Carmel Martin of the National Centre for Epidemiology and Population Health at the ANU, questioned whether access to GP consultation time through Medicare had been equitable for those in greatest need. Her report was based on an investigation of the relationships between patient need and consultations billed as "longer" compared with those billed as "standard". Patient need was represented by factors including chronic disease diagnoses, health status, health risk and social factors such as education. Overseas studies found that patients with longer GP consultations report greater ability to manage their health, illness and lifestyle. People with chronic and complex problems need even longer consultations to deal with medical issues, preventive care needs and living with chronic ill-health. Chronic disease and greater health risk was more likely among the less educated. The authors concluded that greater patient need, other than those with psychosocial problems, was not associated with longer consultations. The study pointed to an "inverse care law", Dr Martin said. "The study highlights a gap in our understanding of the Australian health care system and the need for more research into the situation."