Monash University, Melbourne, VIC, Australia.
University of Western Sydney, Sydney, NSW, Australia.
Med J Aust. 2015 Mar 2;202(4):190-4. doi: 10.5694/mja14.00330.
To examine whether adult use of mental health services subsidised by Medicare varies by measures of socioeconomic and geographic disadvantage in Australia.
DESIGN, SETTING AND PARTICIPANTS: A secondary analysis of national Medicare data from 1 July 2007 to 30 June 2011 for all mental health services subsidised by Better Access to Mental Health Care (Better Access) and Medicare - providers included general practitioners, psychiatrists, clinical psychologists and mental health allied health practitioners.
Service use rates followed by measurement of inequity using the concentration curve and concentration index.
Increasing remoteness was consistently associated with lower service activity; eg, per 1000 population, the annual rate of use of GP items was 79 in major cities and 25 and 8 in remote and very remote areas, respectively. Apart from GP usage, higher socioeconomic disadvantage in areas was typically associated with lower usage; eg, per 1000 population per year, clinical psychologist consultations were 68, 40 and 23 in the highest, middle and lowest advantaged quintiles, respectively; and non-Better Access psychiatry items were 117, 55 and 45 in the highest, middle and lowest advantaged quintiles, respectively.
Our results highlight important socioeconomic and geographical disparities associated with the use of Better Access and related Medicare services. This can inform Australia's policymakers about these priority gaps and help to stimulate targeted strategies both nationally and regionally that work towards the universal and equitable delivery of mental health care for all Australians.
研究澳大利亚医疗保险补贴的心理健康服务是否因社会经济和地理劣势的衡量标准而有所不同。
设计、地点和参与者：对 2007 年 7 月 1 日至 2011 年 6 月 30 日期间全国医疗保险数据的二次分析，涵盖 Better Access to Mental Health Care（Better Access）和 Medicare 补贴的所有心理健康服务，供应商包括全科医生、精神科医生、临床心理学家和心理健康相关健康从业者。
服务使用率，随后使用集中曲线和集中指数测量不公平性。
偏远程度的增加与服务活动的减少呈一致相关；例如，每 1000 人，城市中心地区的 GP 项目年度使用率为 79，而偏远和极偏远地区分别为 25 和 8。除了 GP 使用外，地区的社会经济劣势越高，使用率通常越低；例如，每年每 1000 人，临床心理学家咨询在最高、中间和最低优势五分位数中分别为 68、40 和 23；非 Better Access 精神病项目在最高、中间和最低优势五分位数中分别为 117、55 和 45。
我们的结果突出了与 Better Access 和相关医疗保险服务使用相关的重要社会经济和地理差异。这可以为澳大利亚的政策制定者提供这些优先差距的信息，并有助于在全国和地区层面制定有针对性的战略，为所有澳大利亚人提供普遍和公平的心理健康护理。
