Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia.
Southern Synergy Department of Psychiatry, Monash University, Melbourne, VIC, Australia.
Epidemiol Psychiatr Sci. 2024 Nov 29;33:e70. doi: 10.1017/S2045796024000738.
Achieving equitable healthcare access is a global challenge. Improving whole-population mental health and reducing the global burden of mental disorders is a key recommendation of the 2018 Lancet Global Mental Health Commission, which proposed monitoring national indicators, including the proportion of people with severe mental disorders who are service-users. This study aims to derive an equity indicator from national datasets integrating need, service utilisation and socioeconomic status, and demonstrate its utility in identifying gaps in mental health service use amongst those with the greatest need, thereby guiding equitable healthcare delivery.
We present a case study of a universal health insurance scheme (Medicare) in Australia. We developed the equity indicator using three national datasets. Geographic areas were linked to an area-based socioeconomic deprivation quintile (Census 2016). Per geographic area, we estimated the number with a mental healthcare need using scores ≥30 on the Kessler-10 (Australian National Health Surveys 2015 and 2018), and obtained the number of services used, defined as mental health-related contacts with general practitioners and mental health professionals (Medicare administrative data 2015-2019). We divided the number of services by the population with an estimated mental healthcare need and averaged these use-rates across each socioeconomic deprivation quintile. The equity indicator is the ratio of the use-rates in the least versus most deprived quintiles.
Those estimated to have the greatest need for mental healthcare in 2019 ranged between 8.2% in the most disadvantaged area quintile (Q1) and 2.4% in the least (Q5), corresponding to a proportional increase of 27.7% in Q1 and 19.5% in Q5 since 2015. Equity-indicator-adjusted service rates of 4.2 (3.8-4.6) and 23.9 (22.4-25.4) showed that individuals with the highest need for care residing in Q1 areas received a stark 6 times fewer services compared to their Q5 counterparts, producing an equity indicator of 6.
As the global prevalence of common mental disorders may be increasing, it is crucial to calculate robust indicators evaluating the equity of mental health service use. In this Australian case study, we developed an equity indicator enabling the direct comparison of geographic areas with different need profiles. The results revealed striking inequities that persisted despite publicly-funded universal healthcare, recent service reforms and being a high-income country. This study demonstrates the importance and feasibility of generating such an indicator to inform and empower communities, healthcare providers and policymakers to pursue equitable service provision.
实现公平的医疗保健机会是全球面临的挑战。改善全民心理健康状况，减轻全球精神障碍负担是 2018 年《柳叶刀全球精神卫生委员会》的一项重要建议，该委员会建议监测包括严重精神障碍患者中接受服务者比例在内的国家指标。本研究旨在从整合需求、服务利用和社会经济地位的国家数据集中得出一个公平指标，并展示其在确定最需要服务的人群中精神卫生服务利用差距方面的效用，从而指导公平的医疗保健服务提供。
我们展示了澳大利亚全民医疗保险计划（医疗保险）的案例研究。我们使用三个国家数据集开发了公平指标。地理区域与基于区域的社会经济贫困五分位数（2016 年人口普查）相关联。对于每个地理区域，我们使用 Kessler-10 量表得分≥30 估计有精神卫生保健需求的人数（2015 年和 2018 年澳大利亚国家健康调查），并获得精神卫生相关接触的服务利用数量，定义为与全科医生和精神卫生专业人员的接触（2015-2019 年医疗保险管理数据）。我们将服务数量除以估计有精神卫生保健需求的人口，并在每个社会经济贫困五分位数中平均这些利用率。公平指标是利用率最低和最高五分位数之间的比率。
2019 年，预计最需要精神卫生保健的人数在最不利地区五分位数（Q1）中为 8.2%，在最有利地区五分位数（Q5）中为 2.4%，自 2015 年以来，Q1 地区的比例分别增加了 27.7%和 Q5 地区增加了 19.5%。经过公平指标调整后的服务利用率为 4.2（3.8-4.6）和 23.9（22.4-25.4），表明居住在 Q1 地区的最高护理需求人群接受的服务数量比 Q5 地区的人群少 6 倍，产生了 6 的公平指标。
随着常见精神障碍的全球患病率可能增加，计算评估精神卫生服务利用公平性的稳健指标至关重要。在这项澳大利亚案例研究中，我们开发了一个公平指标，可以直接比较具有不同需求特征的地理区域。结果显示，尽管有公共资助的全民医疗保险、最近的服务改革和作为高收入国家，但仍存在明显的不平等现象。本研究表明，生成此类指标以告知和赋权社区、医疗保健提供者和政策制定者以追求公平的服务提供是重要且可行的。
