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

• Published in: Health policy (Amsterdam) Vol. 123; no. 1; pp. 45 - 50
• Main Authors: Bartram, Mary, Stewart, Jennifer M.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.01.2019; Elsevier Science Ltd
• Subjects: Access; Australia; Backlog; Canada; Community health; Community mental health services; Equity; Health care policy; Health insurance; Health services; Health services utilization; Health surveys; Income; Indexes; Inequality; Insurance coverage; Low income groups; Medicare; Mental health; Mental health services; Parliamentary systems; Polls & surveys; Psychotherapy; Well being; Australia; Canada; Access; Equity; Canada; Australia; Mental health; Income
• ISSN: 0168-8510; 1872-6054
• DOI: 10.1016/j.healthpol.2018.10.011

•Psychologist use is more pro-rich than physician use in both countries.•Psychologist use may be more pro-rich under Canada’s two-tier system.•Despite reform, unmet need is not more equitable in Australia than Canada.•A backlog effect may explain Australian pro-poor utilization and unmet need.•The impact of different Medicare co-payment policies also warrants further exploration. 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.