About the Health Services Research MBS Study
In this secondary data analysis we assess whether adult utilisation of mental health services subsidised by Australian federal national health insurance (Medicare) varies by measures of socio-economic and geographic disadvantage between July 1st 2007 and June 30th 2011. Australia provides national health insurance funding for psychological treatment services, and this funding has increased substantially since 2006. Concerns have been raised as to whether these funded services are distributed equitably such that populations characterised by poorer socio-economic status, where mental health typically is poorer, receive greater servicing. Alternatively the situation might be more one of operation of an inverse-care law where the better off receive more services. The results clearly show significant disparities in non-GP mental health Medicare funded services, whereby people residing in lower socio-economic areas are utilisation services at much lower rates compared to advantaged areas.
Figure 1. Mental health service activity rates (y-axis) for two contrasting metropolitan areas of Melbourne. PTS, Psychological therapy services provided by a Clinical Psychologist. FPS, Focussed psychological strategies provided by allied mental health (i.e. Social workers, Occupational therapists and General Psychologists).
The City of Bayside (blue) is an affluent area that is ranked in the top decile for socio-economic advantage in Australia. Whilst the City of Greater Dandenong (red) has areas with marked disadvantage, and overall is in the bottom 2.5 ranking for socio-economic advantage.
Rate of service use per 1000 people
|City of Bayside||82,077||1,111||10||$1,826|
|City of Greater Dandenong||157,423||945||2.5||$953|
We know that mental illness prevalence is higher in areas with high socio-economic disadvantage, yet the activity rates of Medicare funded mental health services is markedly higher in the City of Bayside compared to the City of Greater Dandenong. For example, Psychiatry services are used at a rate of 180 (per 1000 people) in Bayside and less than half, 81 (per 1000 people) in Dandenong.
Read more about this equity analysis of 4 years of Medicare data at: Meadows GN, Enticott JC, Inder B, Russell GM, Gurr R. Better access to mental health care and the failure of the Medicare principle of universality. Medical Journal of Australia. 2015;202(4):190-5.