Centre for Mental Health Research, Research School of Population Health, The Australian National University, Acton, ACT, Australia.
Brain and Mind Centre, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Aust N Z J Psychiatry. 2019 Nov;53(11):1052-1058. doi: 10.1177/0004867419865335. Epub 2019 Jul 31.
To explore the impact of proposed expansion of Australia's Better Access Program and alternatives.
Australia's Better Access Program, which costs taxpayers AUD28 million every week, is once again the focus of national political and professional scrutiny. The current Medicare Review calls for a massive expansion. This article reviews its history and context. It challenges the recommendations made by the Review. It also provides three scenarios which model the proposed expansion, with significant implications for consumers, the workforce and taxpayers.
The capacity for continued growth of the Program is demonstrated. At the same time.
There has been recent evidence suggesting the impact of the programme on key mental health indicators in Australia has been negligible, while also perpetuating social, economic and geographic inequities. While advocacy for increased mental health expenditure is easy, active reform of existing patterns of service is hard. Nonetheless, this article suggests that it is timely to reconsider the structure and scale of this AUD1.5 billion annual investment, which has the potential to grow to up to AUD10 billion per year over the next decade. In our view, it is possible to make the programme fit for purpose in the 21st century. Specifically, the principal focus could be shifted to better support the interdisciplinary, team-based care that responds to the needs of people with more complex mental health problems. An increased role for incorporation of digital technologies alongside clinical services is part of the mix. The combination of changes suggested would suggest that the programme could be rebranded as 'Better Access and Quality'. This shift in the primary focus of the clinical programme away from brief interventions for those with lower needs to more sustained interventions with those with greater impairment requires new service models, as well as new regionally based health care systems. In addition, we propose specific outcomes that can be measured regionally, and collated nationally, to properly evaluate the impact of the programme and drive systemic quality improvement.
探讨扩大澳大利亚“更好获取途径计划”（Better Access Program）及其替代方案的影响。
澳大利亚“更好获取途径计划”每周耗费纳税人 2800 万澳元，再次成为全国政治和专业审查的焦点。当前的医疗保险审查呼吁进行大规模扩张。本文回顾了其历史和背景，对审查建议提出了挑战，并提供了三种方案模型，对消费者、劳动力和纳税人都有重大影响。
该计划的持续增长能力得到了证明。同时。
最近有证据表明，该计划对澳大利亚关键心理健康指标的影响微不足道，同时也延续了社会、经济和地理方面的不平等。虽然倡导增加心理健康支出很容易，但积极改革现有的服务模式却很难。尽管如此，本文认为，现在是重新考虑每年 15 亿澳元投资结构和规模的时候了，在未来十年内，该计划有可能增长到每年 100 亿澳元。在我们看来，使该计划在 21 世纪适应需要是有可能的。具体来说，可以将重点转移到更好地支持跨学科、团队合作的护理模式，以满足具有更复杂心理健康问题的人的需求。纳入数字技术与临床服务相结合是其中的一部分。建议的变革组合表明，可以将该计划重新命名为“更好获取途径和质量”。这种临床计划的主要重点从满足低需求人群的简短干预转移到为更有残障人士提供更持续的干预，需要新的服务模式以及新的基于区域的医疗保健系统。此外，我们提出了可以在区域层面衡量并在全国范围内收集的具体结果，以正确评估该计划的影响并推动系统质量改进。
