Mental health consultations in the perinatal period: a cost-analysis of Medicare services provided to women during a period of intense mental health reform in Australia
Georgina M. Chambers A I , Sean Randall B , Cathrine Mihalopoulos C , Nicole Reilly D , Elizabeth A. Sullivan E , Nicole Highet F , Vera A. Morgan G , Maxine L. Croft G , Mary Lou Chatterton C and Marie-Paule Austin D HA National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women’s and Children’s Health, UNSW Sydney, Level 1, AGSM Building, Kensington, NSW 2052, Australia.
B Centre for Population Health Research, Curtin University, Kent Street, Bentley, WA 6160, Australia. Email: sean.randall@curtin.edu.au
C Deakin Health Economics, School of Health and Social Development, Deakin University, Locked Bag 20001, Geelong, Vic. 3220, Australia. Email: cathy.mihalopoulos@deakin.edu.au; m.chatterton@deakin.edu.au
D Perinatal and Women’s Mental Health Unit, St John of God Burwood Hospital and School of Psychiatry, UNSW Sydney, 13 Grantham Street, Burwood, NSW 2134, Australia. Email: n.reilly@unsw.edu.au; m.austin@unsw.edu.au
E Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia. Email: elizabeth.sullivan@uts.edu.au
F Centre of Perinatal Excellence, PO Box 122, Flemington, Vic. 3031, Australia. Email: nicole.highet@cope.org.au
G Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Level 3, Medical Research Foundation Building, Rear 50 Murray Street, Perth, WA 6000, Australia. Email: vera.morgan@uwa.edu.au; maxine.croft@uwa.edu.au
H The Black Dog Institute, Hospital Rd, Randwick, NSW 2031, Australia.
I Corresponding author. Email: g.chambers@unsw.edu.au
Submitted: 8 May 2017 Accepted: 3 October 2017 Published: 5 December 2017
Abstract
Objective To quantify total provider fees, benefits paid by the Australian Government and out-of-pocket patients’ costs of mental health Medicare Benefits Schedule (MBS) consultations provided to women in the perinatal period (pregnancy to end of the first postnatal year).
Method A retrospective study of MBS utilisation and costs (in 2011–12 A$) for women giving birth between 2006 and 2010 by state, provider-type, and geographic remoteness was undertaken.
Results The cost of mental health consultations during the perinatal period was A$17.5 million for women giving birth in 2007, rising to A$29 million in 2010. Almost 9% of women giving birth in 2007 had a mental health consultation compared with more than 14% in 2010. An increase in women accessing consultations, along with an increase in the average number of consultations received, were the main drivers of the increased cost, with costs per service remaining stable. There was a shift to non-specialist care and bulk billing rates increased from 44% to 52% over the study period. In 2010, the average total cost (provider fees) per woman accessing mental health consultations during the perinatal period was A$689, and the average cost per service was A$133. Compared with women residing in regional and remote areas, women residing in major cities where more likely to access consultations, and these were more likely to be with a psychiatrist rather than an allied health professional or general practitioner.
Conclusion Increased access to mental health consultations has coincided with the introduction of recent mental health initiatives, however disparities exist based on geographic location. This detailed cost analysis identifies inequities of access to perinatal mental health services in regional and remote areas and provides important data for economic and policy analysis of future mental health initiatives.
What is known about the topic? The mental healthcare landscape in Australia has changed significantly over the last decade, with the introduction of numerous policies aimed at prevention, screening and improving access to treatment. Several of these policies have been aimed at perinatal depression, which affects 15% of women giving birth.
What does this paper add? This is the first population-based, cost analysis of mental health consultations during the perinatal period (pregnancy to end of the first postnatal year) in Australia. Almost 9% of women giving birth in 2007 had a mental health consultation funded though the MBS, compared with more than 14% in 2010. Over the same period there was a shift from psychiatric consultations to allied health and primary care consultations. In 2010, the total cost (provider fee) of these consultations was A$29 million, equating to an average cost per woman of A$689 and A$133 per service. Despite the changing policy environment, significant disparities exist in access to care according to geographic remoteness.
What are the implications for practitioners? Recent policy initiatives have resulted in increasing access to mental health consultations for women around the time of childbirth. However, policies are needed that target women outside of major cities. Furthermore, evidence is needed on whether the increase in access has resulted in improved mental health outcomes for women at this vulnerable time. The cost data provided by this study are unique and will inform future mental health policy development and health economic evaluations.
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