Objective: To compare the Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS initiative with the Better Outcomes in Mental Health Care initiative, to test contentions that Better Access is used more often by advantaged major city patients and that the role of GPs has been reduced to that of referrers.
Design and setting: Analysis of Bettering the Evaluation and Care of Health data relating to management of depression from April 1998 to March 2011, with the Better Outcomes period defined as January 2002 to October 2006 and the Better Access period defined as November 2006 to December 2011.
Results: During the study period, rates of depression management increased and rates of referrals to psychiatrists halved. Compared with Better Outcomes, Better Access resulted in: increased depression management for advantaged major city and disadvantaged non-major city patients (16.0% and 21.5% increases, respectively); a small decrease in prescribing for advantaged major city patients; decreases in GP counselling; increases in referrals to psychologists for all patient groups (three- to fourfold increases), with advantaged major city patients referred more often than patients in other groups; and increases in mental health care item claims for all patient groups (44–65-fold increases), with more claims for advantaged major city patients than both non-major city patient groups.
Conclusion: Far from becoming “glorified referrers”, GPs remain heavily involved in the management of depression. Better Access brought about an enormous increase in access to primary care management of depression, although advantaged major city patients gained most. Any changes to the system must not compromise the strong improvements in access that have occurred for all groups.
- 1. Crosbie D, Rosenberg S; COAG Mental Health Reform. Mental Health and the new Medicare Services: 2nd report November 2006 – August 2008. Canberra: Mental Health Council of Australia, 2008. http://www.mhca.org.au/index.php/component/rsfiles/download? path=Mental%20Health%20Services/COAG%2 0MBS%202nd%20Report%20Sept%202008.pdf&Itemid=539 (accessed Jun 2012).
- 2. Rosenberg S, Hickie IB. Were the budgetary reforms to the Better Access to Mental Health Care initiative appropriate? No. Med J Aust 2011; 194: 595. <MJA full text>
- 3. Pirkis J, Ftanou M, Williamson M, et al. Australia’s Better Access initiative: an evaluation. Aust N Z J Psychiatry 2011; 45: 726-739.
- 4. Jorm AF. Australia’s Better Access initiative: do the evaluation data support the critics? Aust N Z J Psychiatry 2011; 45: 700-704.
- 5. Rosenberg S, Hickie I. How to tackle a giant: creating a genuine evaluation of the Better Access Program. Australas Psychiatry 2010; 18: 496-502.
- 6. Harrison CM, Britt H. The rates and management of psychological problems in Australian general practice. Aust N Z J Psychiatry 2004; 38: 781-788.
- 7. Britt H, Miller GC, Charles J, et al. General practice activity in Australia 2010–11. General practice series no. 29. Sydney: Sydney University Press, 2011. http://purl.library.usyd.edu.au/sup/9781920899868 (accessed Jun 2012).
- 8. Australian Bureau of Statistics. An introduction to Socio-Economic Indexes for Areas (SEIFA). Canberra: ABS, 2006. (ABS Cat. No. 2039.0.) http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/D729075E079F9FDECA2574170011B088/$File/20390_2006.pdf (accessed Feb 2009).
- 9. Australian Bureau of Statistics. Australian standard geographical classification. Canberra: ABS, 2008. (ABS Cat. No. 1216.0.) http://www. abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/1216.0Jul%202008?OpenDocument (accessed Dec 2008).
- 10. Classification Committee of the World Organization of Family Doctors. International Classification of Primary Care. 2nd ed. Oxford: Oxford University Press, 1998.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.