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.