It has been repeatedly claimed by critics that Medicare supported psychological services fail to reach disadvantaged groups, but is that claim actually true? We decided to find out by calculating the number of disadvantaged people, in real terms, who have been reached by the Better Access to Mental Health Care initiative. Although we had anticipated that criticisms of the scheme were overblown, it was surprising to learn just how far the truth has been stretched by those seeking to justify scaling back Medicare support in mental health care.
NOTE: You might also like to read the next update on this piece, which recalculates the figures in a more comprehensive way.
Thankfully there is a great deal of information available about the Better Access initiative from a large evaluation of the program which took place a few years ago. This report included a whole chapter dedicated to analysing figures from the Medicare Benefits Schedule (MBS). Part of that analysis was to calculate the proportion of people using the program from socio-economically disadvantaged groups. The authors of the report achieved this by taking the postcode of where a person lived as being an indicator of their socioeconomic status, using what is called the Index of Relative Socioeconomic Disadvantage (IRSD). Setting aside the obvious problems associated with labelling someone as being disadvantaged on the basis of what postcode they live in, we used these figures to make our calculations because these are the same statistics that critics have relied on to take aim at the program. The evaluation report displays on Table 3.10 the number of people who accessed psychological treatment in Medicare across 5 segments of Australian postcodes, ranked from ‘least disadvantaged’ to ‘most disadvantaged’. Wanting to adopt the most stringent approach possible, we opted to only include people from the ‘most disadvantaged’ group, keeping in mind that there are many thousands of other Australians who are in fact disadvantaged but live in postcodes that the IRSD system classifies differently. The table shows that just a few years after operation in 2009, the Better Access initiative reached 149,683 people from the ‘most disadvantaged’ group. Therefore we can safely say that around 150,000 disadvantaged people access the scheme each and every year. Further to this, when you factor in an annual growth rate of around 15% each year and the fact that many disadvantaged people live in postcodes with a higher ranking, it becomes clear that the Better Access initiative has reached over a million disadvantaged Australians since the program was launched in 2006.
As many of you would know, critics of Medicare-supported services have compared the Better Access initiative to the ATAPS program, claiming that the latter reaches more disadvantaged people. Each year the ATAPS program is given a brief and standard report which generates some useful statistics, but unfortunately these evaluation reports do not provide a lot of information that can be directly compared to the figures from the Better Access evaluation. What they do provide however, is an assessment of whether a person accessing care is on a ‘low income’ with a yes/no format. At first glance these figures appear quite promising, showing that an average of 62% of people are financially disadvantaged (with a maximum of 65% in 2005 and a minimum of 57% in 2011). The most recent report shows that since they started gathering data in July 2003 there have been a total of 273,639 people referred to ATAPS, of which 213,045 people actually received psychological treatment. With 62% of people being identified as having a low income, the ATAPS program has delivered psychological treatment to around 132,088 disadvantaged people. So we can safely say that going by the most generous estimate the ATAPS program has reached around 150,000 people since it began in 2001.
So let’s put these two figures side by side and review the situation:
The ATAPS program has reached around 150,000 disadvantaged people across the last decade, whereas the Better Access initiative reaches the same number of people every single year.
What this shows is the magnitude of reach that Medicare has, regardless of any barriers there might be to service delivery. This crucial point seems to have been overlooked by most commentators in the discussion about the much awaited National Report Card on Mental Health released last week. The report card identifies that there are clear benefits to providing Medicare-supported psychological services, which have allowed thousands of Australians with a mental health condition to access treatment for the first time. Like other recent evaluations of the Better Access the report highlights that the greatest barrier to accessing psychological treatment has been associated with limited access to GPs from one region to another (page 43):
We already know from other reports that the challenge of reaching disadvantaged groups is a problem shared by all MBS items for exactly the same reason. Research shows that the Better Access initiative significantly improved access to psychological treatment for every sector in our society. Importantly, the rate of growth in accessing treatment is highest amongst the most disadvantaged groups, particularly for young people with a mental health condition.
What saddens me the most is the enormous amount of spin and the lack of practical common sense coming from critics and politicians seeking to justify what amounts to a budget cut. It has led to a situation where political representatives are no longer considering the actual number of disadvantaged people being helped. These are real people whose lives should matter to all of us. Both the ATAPS program and the Better Access initiative are needed in Australia, which means that we just can’t afford to trade off one mental health care program for the other.
The advantage of Better Access is that Medicare reaches people in every community and allows people a choice of a local mental health practitioner. Conversely, the strength of ATAPS is that it targets some of the gaps and niche areas where people aren’t connecting with Medicare as successfully. If it isn’t clear from the calculations shown above that scaling back Medicare support for psychological treatment will do a lot more harm than good to people who are already disadvantaged, then I don’t honestly know how else to get through to our political representatives.
Addendum
The latest evaluation report for ATAPS issued in March 2012 showed that 70,647 services had been delivered in the 2011-2012 financial year. MBS data indicates that across the same period 2,397,255 services were delivered via Medicare through the Better Access initiative. This shows that the ATAPS programs is operating at less than 5% of the capacity of the Better Access initiative, despite a significant funding boost. Even when we factor in the proportion of disadvantaged people reached by each program it is clear that the ATAPS program just doesn’t have anywhere near the capacity to meet the need for mental health care. The ATAPS program has a rate of 62% of reaching patients that GP’s deem to be on a ‘low income’, which in the latest recorded period represents 43,801 people. By comparison, the Better Access initiative has a rate of reaching 12.94% of people living in the ‘most disadvantaged’ quintile, which across the same period represents 310,205 people. That is, Medicare currently reaches over 7 times the amount of disadvantaged people as ATAPS. These latest figures clearly demonstrate that the ATAPS program cannot meet the need for treatment in mental health care, even when we limit consideration to the most disadvantaged groups in our society.
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