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Income-based inequities in access to psychotherapy and other mental health services in Canada and Australia

TitleIncome-based inequities in access to psychotherapy and other mental health services in Canada and Australia
Year of Publication2019
AuthorsBartram, M. H., and Stewart J. M.
JournalHealth Policy
Volume123
Pages45 - 50
Keywordsaccess, australia, canada, equity, income, mental health
Abstract

This paper compares income-based inequities in access to psychotherapy and other mental health services in Canada and Australia, two federal parliamentary systems with sharply contrasting responses to high rates of unmet need. Income-based inequity is measured by need-standardized concentration indices, using comparable data from the Canadian Community Health Survey 2011–2012 and the Australian National Survey of Mental Health and Well-Being 2007. The results indicate that utilization of psychologist services is more concentrated at higher income levels (i.e. pro-rich) than the other provider groups in both countries, and may be more pro-rich in Canada than in Australia. While the distribution of unmet need for psychotherapy was expected (as a negative indicator of access) to be more concentrated at lower income levels (i.e. pro-poor) under Canada's two-tier system, unmet need was not more equitable in Australia despite expanded public insurance coverage. As psychotherapy was made universally affordable for the first time in Australia in 2006, a possible backlog effect may have driven up both service utilization and unmet need, particularly among lower-income Australians. The impact of different Medicare co-payment policies also warrants further exploration.

URLhttps://www.sciencedirect.com/science/article/pii/S0168851018305992
DOI10.1016/j.healthpol.2018.10.011
Document URLhttps://reader.elsevier.com/reader/sd/pii/S0168851018305992?token=3B0FBFD7179314773352997F66D33A36CDB6497DA14CB20A51DD56B3C483E5D943A4365124284A6CD93B77D234C4B271