Evaluation shows value for money in Better Access program


A rigorous evaluation of the Better Access program led by  the Centre for Health Policy, Programs and Economic (CHPPE) has provided strong  evidence that the program delivers good value for Australian taxpayers. Better  Access provided Medicare-funded psychological care to more than two million  Australians over a three-year period.
Australia’s most comprehensive  evaluation of a Medicare-based program, the Better Access research was conducted by CHPPE in collaboration with colleagues at the University of  Queensland. CHPPE, part of the Melbourne School of Population and Global Health at the  University of Melbourne, injected much needed substance into the public  debate about what had become a controversial program. The evaluation’s results  were cited by a Senate inquiry, reported in mainstream and academic media, were  published in journals, and informed changes to the program itself.
The commonwealth government’s Better  Access initiative was introduced in late 2006 and enabled General Practitioners  (GPs) to refer consumers to selected allied health professionals  for a set number of sessions of psychological care. Critics had focused on the  unanticipated level of funding required for the program, and had contended that  it had only reached the “worried well”, people from wealthy metropolitan areas,  and those who were already “in the system”.
CHPPE’s Director, Professor Jane  Pirkis, said the evaluation drew on the best available evidence to disprove  some key objections to the program. “We found that uptake of Better Access services has  been high in absolute terms, even among relatively disadvantaged groups,” she  said. Just over two million  people received Better Access services during the three-year observation  period. This significantly increased from 33.8  people   in  every  1000 in 2007 to 52.8 people in every  1000 in 2009.
“Uptake was highest for people in capital cities and in areas of high  socio-economic advantage, but those in remote areas and areas of the lowest  socio-economic advantage experienced the greatest growth in uptake over the  three-year period,” she said. “We also found that Better Access is  reaching significant numbers who have not previously accessed mental health  care. We found that more than 50 per cent of consumers seen by psychologists  are 'new' to mental health care.”
Professor Pirkis also said the program was treating many people with  severe symptoms and debilitating levels of distress, with more than 80 per cent  of consumers seen by psychologists having been assessed as experiencing high or  very high levels of psychological distress.
Preliminary analysis of self-reported  outcomes and cost data for consumers seen by psychologists suggested that  Better Access provides good value for money, she said. “We calculated that the  average package of care provided by a psychologist, including the cost of the referral and review by the GP, was $753. Others have estimated that  optimal treatment for anxiety or depressive disorders would cost about $1100.”
The evaluation drew on 20 data sources,  including analyses of Medicare and other administrative datasets, analyses of  existing epidemiological and research datasets, and stakeholder  interviews/surveys and consultations. “We don’t know of any other evaluations  of Medicare-based programs that have been as comprehensive as this,” Professor  Pirkis said. “Most have done little more than examine service utilisation and  cost data.

“Our study also included studies of  consumer outcomes, the largest of which we conducted ourselves. This examined  outcomes of Better Access care for 883 consumers.” Consumers had reported  positive outcomes on standardised measures of psychological distress, depression, anxiety and stress, and expressed satisfaction with their care  under Better Access.
CHPPE has published several journal articles  from the empirical data and has others in production. “We’re pleased with these  academic achievements, but we’re happier still that the evaluation has had an  impact on the debate around Better Access,” Professor Pirkis said. “This  research has taken it from a level that was based purely on opinion and  conjecture to one which has systematically drawn on the best available  evidence.”

Caption: Professor Jane Pirkis.