Department of Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia.
Department of Psychiatry, Victorian Institute of Forensic Mental Health, Melbourne, VIC, Australia.
Front Public Health. 2023 Mar 1;11:1014302. doi: 10.3389/fpubh.2023.1014302. eCollection 2023.
At the beginning of the COVID-19 pandemic, it was foreseen that the number of face-to-face psychiatry consultations would suffer a reduction. In order to compensate, the Australian Government introduced new Medicare-subsidized telephone and video-linked consultations. This study investigates how these developments affected the pre-existing inequity of psychiatry service delivery in Australia.
The study analyses five and a half years of national Medicare data listing all subsidized psychiatry consultation consumption aggregated to areas defined as Statistical Area level 3 (SA3s; which have population sizes of 30 k-300 k). Face-to-face, video-linked and telephone consultations are considered separately. The analysis consists of presenting rates of consumption, concentration graphs, and concentration indices to quantify inequity, using Socio Economic Indexes for Areas (SEIFA) scores to rank the SA3 areas according to socio-economic disadvantage.
There is a 22% drop in the rate of face-to-face psychiatry consultation consumption across Australia in the final study period compared with the last study period predating the COVID-19 pandemic. However, the loss is made up by the introduction of the new subsidized telephone and video-linked consultations. Referring to the same time periods, there is a reduction in the inequity of the distribution of face-to-face consultations, where the concentration index reduces from 0.166 to 0.129. The new subsidized video-linked consultations are distributed with severe inequity in the great majority of subpopulations studied. Australia-wide, video-linked consultations are also distributed with gross inequity, with a concentration index of 0.356 in the final study period. The effect of this upon overall inequity was to cancel out the reduction of inequity resulting from the reduction of face-to face appointments.
Australian subsidized video-linked psychiatry consultations have been distributed with gross inequity and have been a significant exacerbator of the overall inequity of psychiatric service provision. Future policy decisions wishing to reduce this inequity should take care to reduce the risk posed by expanding telepsychiatry.
在 COVID-19 大流行开始时，预计面对面精神病学咨询的数量将会减少。为了弥补这一损失，澳大利亚政府引入了新的医疗保险补贴的电话和视频咨询。本研究旨在调查这些发展变化如何影响澳大利亚现有的精神病服务提供方面的不平等现象。
本研究分析了五年半的国家医疗保险数据，列出了所有补贴精神病学咨询消费的汇总数据，这些数据按照定义的统计区域 3 级（SA3；人口规模为 30k-300k）进行分类。分别考虑面对面、视频链接和电话咨询。分析包括呈现消费率、集中图和集中指数，以量化不平等现象，并使用社会经济区域指数（SEIFA）分数根据社会经济劣势对 SA3 区域进行排名。
与 COVID-19 大流行前的最后一个研究期相比，澳大利亚全国面对面精神病学咨询消费率在最后一个研究期下降了 22%。然而，这一损失被新引入的补贴电话和视频咨询所弥补。在同一时期，面对面咨询分布的不平等程度有所降低，集中指数从 0.166 降至 0.129。新引入的补贴视频咨询在研究的绝大多数亚人群中分布不均，存在严重的不平等现象。在澳大利亚全国范围内，视频咨询的分配也存在严重的不平等现象，在最后一个研究期的集中指数为 0.356。这对整体不平等的影响是抵消了由于面对面预约减少而导致的不平等程度降低。
澳大利亚补贴的视频精神病学咨询分配存在严重的不平等现象，是导致精神卫生服务提供整体不平等加剧的重要因素。未来希望减少这种不平等的政策决策应注意降低扩大远程精神病学服务带来的风险。
