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It has been repeatedly claimed by critics\u00a0that Medicare supported psychological services fail to reach disadvantaged groups, but is that claim\u00a0actually true? We decided to find out by calculating the number of\u00a0disadvantaged people, in real terms,\u00a0who have been\u00a0reached by the Better Access to Mental Health Care<\/em> 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.<\/p>\n NOTE:<\/strong> You might also like to read the next update on this piece<\/a>, which recalculates the figures in a more comprehensive way.<\/em><\/p>\n Thankfully there is a great deal of information available about the <\/span>Better Access<\/em> initiative from <\/span>a large evaluation<\/a> of the program which took place a few years ago. This report included <\/span>a whole chapter<\/a> dedicated to analysing figures from the Medicare Benefits Schedule (MBS). <\/span>Part of that analysis<\/a> was to calculate the proportion of people using the program from socio-economically disadvantaged groups. The authors of the report\u00a0achieved this by\u00a0taking the postcode of where a person lived as being an indicator of their socioeconomic status, using what is called the <\/span>Index of Relative Socioeconomic Disadvantage<\/a> (IRSD).\u00a0Setting aside the <\/span>obvious problems<\/a> associated with labelling someone as being disadvantaged on the basis of what postcode they live in, we used these figures to make our calculations\u00a0because these are\u00a0the same\u00a0statistics that critics have relied on to take aim at the program. The evaluation report <\/span>displays on Table 3.10<\/a> the number of people who accessed psychological treatment in Medicare across 5\u00a0segments\u00a0of Australian postcodes, ranked from \u2018least disadvantaged\u2019 to \u2018most disadvantaged\u2019.\u00a0Wanting to adopt the most stringent approach possible, we opted to only include people from the \u2018most disadvantaged\u2019 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,\u00a0the Better Access initiative reached 149,683 people from the \u2018most disadvantaged\u2019 group. Therefore we can safely say that\u00a0around 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\u00a0initiative has reached over a million disadvantaged Australians since the program was launched in 2006.<\/span><\/p>\n As many of you\u00a0would know, critics of Medicare-supported services have compared the Better Access<\/em> initiative to the ATAPS program, claiming that the latter reaches more disadvantaged people. Each year the ATAPS program\u00a0is\u00a0given\u00a0a brief and\u00a0standard\u00a0report which generates some\u00a0useful statistics, but unfortunately these evaluation reports<\/a> do not provide a lot of information that can be directly compared to the figures from the Better Access<\/em> evaluation. What they do provide however, is an assessment of whether a person accessing care is on a \u2018low income\u2019 with a yes\/no format. At first glance these figures appear quite promising,\u00a0showing that an average of 62% of people are financially disadvantaged (with a maximum of 65% in 2005 and a\u00a0minimum of 57% in 2011). The most recent report<\/a> 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.\u00a0With 62% of people being identified as having a\u00a0low income,\u00a0the ATAPS program\u00a0has delivered psychological treatment to around 132,088 disadvantaged people.\u00a0So\u00a0we can safely say that going by the most generous estimate the ATAPS program\u00a0has reached around 150,000\u00a0people since it began in 2001.<\/p>\n So let\u2019s put these two figures side by side and review the situation:<\/p>\n The ATAPS program has reached around 150,000 disadvantaged people across the last decade<\/span>, whereas the Better Access<\/em> initiative reaches the same number of people every single year<\/span>.<\/strong><\/p>\n What this shows\u00a0is the magnitude of reach that Medicare has, regardless of any barriers there might be\u00a0to service delivery. This crucial point seems to have been\u00a0overlooked by most commentators\u00a0in the\u00a0discussion about the much awaited\u00a0National Report Card on Mental Health<\/a><\/em> 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<\/em> 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):<\/p>\n We\u00a0already know from other\u00a0reports\u00a0that the\u00a0challenge of reaching disadvantaged groups is a problem shared by all MBS items for exactly the same reason. Research\u00a0shows that the Better Access<\/em> initiative\u00a0significantly\u00a0improved access<\/a> to psychological treatment for\u00a0every\u00a0sector in our\u00a0society. Importantly, the rate of growth in accessing treatment is highest amongst the most disadvantaged<\/a> groups, particularly for young people with a mental health condition.<\/p>\n What saddens me the most is the enormous amount of spin and the lack of practical common sense\u00a0coming from\u00a0critics 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<\/em> initiative are needed in Australia, which means that\u00a0we just can\u2019t afford to\u00a0trade off one mental health care program for the other.<\/p>\n The advantage of Better Access<\/em> is that Medicare\u00a0reaches\u00a0people 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\u00a0and niche areas\u00a0where people\u00a0aren\u2019t connecting with Medicare as successfully.\u00a0If it isn\u2019t clear from the calculations shown above that\u00a0scaling back Medicare support for psychological treatment will\u00a0do a lot more harm than\u00a0good\u00a0to people who are already disadvantaged, then\u00a0I don\u2019t honestly know how else to get through to our political representatives.<\/p>\n 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\u2019t 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\u2019s deem to be on a \u2018low income\u2019, 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 \u2018most disadvantaged\u2019 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.<\/em><\/p>\n Your thoughts?<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":" It has been repeatedly claimed by critics\u00a0that Medicare supported psychological services fail to reach disadvantaged groups, but is that claim\u00a0actually true? We decided to find out by calculating the number of\u00a0disadvantaged people, in real terms,\u00a0who have been\u00a0reached by the Better Access to Mental Health Care initiative. Although we had anticipated that criticisms of the scheme […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[45],"tags":[],"class_list":["post-367","post","type-post","status-publish","format-standard","hentry","category-news"],"_links":{"self":[{"href":"https:\/\/drben.com.au\/index.php?rest_route=\/wp\/v2\/posts\/367","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drben.com.au\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drben.com.au\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drben.com.au\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drben.com.au\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=367"}],"version-history":[{"count":3,"href":"https:\/\/drben.com.au\/index.php?rest_route=\/wp\/v2\/posts\/367\/revisions"}],"predecessor-version":[{"id":1437,"href":"https:\/\/drben.com.au\/index.php?rest_route=\/wp\/v2\/posts\/367\/revisions\/1437"}],"wp:attachment":[{"href":"https:\/\/drben.com.au\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=367"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drben.com.au\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=367"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drben.com.au\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=367"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}The further you live from a major city or inner regional area your access to a GP declines and you are less likely to have a GP mental health treatment plan\u201d<\/div>\nAddendum<\/em><\/strong><\/h3>\n