The Impact of Telepsychiatry on Spatial Equity of Medicare-Reimbursed Private Psychiatric Service Utilisation Across States and Territories in Australia (2005–2023): A Time Series Analysis

Abstract

Objective

To examine the trend of locational equity in utilising Medicare-reimbursed psychiatric consultations (face-to-face and telepsychiatry) across states/territories.

Design

Time series analysis of administrative data.

Setting

Medicare-reimbursed private psychiatric consultations.

Main Outcome Measures

Greater coefficients of variation (CVs) represented higher state/territory variations in per capita consultations (2005 Q3–2023 Q4). We ran an autoregressive integrated moving average model for telepsychiatry-related CV change, with restricted rural-remote telepsychiatry items (2005–2022) and unrestricted telepsychiatry items (2020 Q1–2023 Q4) as the predictors. We examined the association between distance from mean per capita consultations and the fraction of per capita telepsychiatry consultations using state/territory-level data in another regression analysis, with telehealth legislative policy changes as another independent variable.

Results

Including telepsychiatry items since their introduction resulted in lower all-item CVs (i.e., reduced state/territory variation) than the corresponding CVs for face-to-face items only. The rural-remote-restricted telepsychiatry items had a larger effect than the unrestricted ones. Every 1000 restricted consultations were associated with 0.287 units of CV improvement (i.e., reduction in regional variation), in contrast to 0.007 units per 1000 consultations for unrestricted items. Telehealth-enabling policy changes significantly modified the association between distance from mean per capita face-to-face consultations and the fraction of telepsychiatry consultations. Lower per capita face-to-face consultations were associated with higher telepsychiatry fractions.

Conclusion

Telepsychiatry may help improve mental health equity. Bulk-billed, incentivised telepsychiatry for rural and remote areas may enhance regional health access.