Disparities in access to health care in Australia for people with mental health conditions
L. Corscadden
A B D , E. J. Callander A and S. M. Topp C
A Australian Institute of Tropical Health and Medicine, James Cook University, Qld 4812, Australia. Email: emily.callander@jcu.edu.au
B Bureau of Health Information, Level 11, 67 Albert Avenue, Chatswood, NSW 2067, Australia.
C College of Public Health, Medical and Veterinary Sciences, James Cook University, Qld 4812, Australia. Email: stephanie.topp@jcu.edu.au
D Corresponding author. Email: lisa.corscadden@health.nsw.gov.au
Australian Health Review 43(6) 619-627 https://doi.org/10.1071/AH17259
Submitted: 13 November 2017 Accepted: 12 June 2018 Published: 17 July 2018
Journal Compilation © AHHA 2019 Open Access CC BY-NC-ND
Abstract
Objective One aim of Australia’s Equally Well National Consensus Statement is to improve monitoring of the physical health of people with mental health conditions, which includes measures of accessibility and people’s experiences of physical health care services. The present analysis contributes to this aim by using population survey data to evaluate whether, and in what domains, Australians with a mental health condition experience barriers in accessing care when compared with Australians without a mental health condition.
Methods The 2016 Commonwealth Fund International Health Policy Survey includes a sample of 5248 Australian adults. Access to care was measured using 39 survey questions from before to after reaching services. Multivariable logistic regression models were used to identify disparities in barriers to access, comparing experiences of people with and without a self-reported mental health condition, adjusting for age, sex, immigrant status, income and self-rated health.
Results Australians with mental health conditions were more likely to experience barriers for 29 of 39 access measures (odds ratio (OR) >1.55; P < 0.05). On average, the prevalence of barriers was 10 percentage points higher for those with a condition. When measured as ratios, the largest barriers for people with mental health conditions were for affordability. When measured as percentage point differences, the largest disparities were observed for experiences of not being treated with respect in hospital. Disparities remained after adjusting for income, rurality, education, immigrant status and self-rated health for 25 of 39 measures.
Conclusion Compared with the rest of the community, Australians with mental health conditions have additional challenges negotiating the health system, and are more likely to experience barriers to access to care across a wide range of measures. Understanding the extent to which people with mental health conditions experience barriers throughout the pathway to accessing care is crucial to inform care planning and delivery for this vulnerable group. Results may inform improvements in regular performance monitoring of disparities in access for people with mental health conditions.
What is known about this topic? A stated national aim of the Equally Well National Consensus Statement is to improve monitoring of the physical health and well-being of people with mental health conditions through measures of service accessibility and people’s experiences of physical healthcare services.
What does this paper add? This paper highlights areas in which health services are not providing equal access to overall care for people with mental health conditions. The analysis offers quantitative evidence of ‘red flag areas’ where people with mental health conditions are significantly more likely to experience barriers to access to care.
What are the implications for practitioners? Systematic attention across the health system to making care more approachable and accessible for people with mental health conditions is needed. Practitioners may be engaged to discuss possible interventions to improve access disparities for people with mental health conditions.
Additional keywords: accessibility of healthcare services, equity, vulnerable groups.
References
[1] National Mental Health Commission (NMHC). Equally well consensus statement: improving the physical health and wellbeing of people living with mental illness in Australia. Sydney: NMHC; 2016.[2] Australian Institute for Health and Welfare (AIHW). Australia’s health 2016. Canberra: AIHW; 2016.
[3] Penchansky R, Thomas JW. The concept of access – definition and relationship to consumer satisfaction. Med Care 1981; 19 127–40.
| The concept of access – definition and relationship to consumer satisfaction.Crossref | GoogleScholarGoogle Scholar |
[4] Levesque JF, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health 2013; 12 18
| Patient-centred access to health care: conceptualising access at the interface of health systems and populations.Crossref | GoogleScholarGoogle Scholar |
[5] Franks P, Fiscella K. Reducing disparities downstream: prospects and challenges. J Gen Intern Med 2008; 23 672–7.
| Reducing disparities downstream: prospects and challenges.Crossref | GoogleScholarGoogle Scholar |
[6] Steering Committee for the Review of Government Service Provision. Report on government services 2016. Canberra: Productivity Commission; 2016.
[7] Australian Bureau of Statistics (ABS). Patient experiences in Australia: summary of findings 2015–16. Canberra: ABS; 2016.
[8] Australian Bureau of Statistics (ABS). National survey of mental health and wellbeing: summary of results 2007. Canberra: ABS; 2008.
[9] Australian Institute of Health and Welfare (AIHW). Mental health services – in brief 2016. Canberra: AIHW; 2016.
[10] Department of Health and Ageing. National mental health report 2013: tracking progress of mental health reform in Australia 1993–2011. Canberra: Commonwealth of Australia; 2013.
[11] Schoen C, Osborn R, Squires D, Doty MM, Pierson R, Applebaum S. How health insurance design affects access to care and costs, by income, in eleven countries. Health Aff (Millwood) 2010; 29 2323–34.
| How health insurance design affects access to care and costs, by income, in eleven countries.Crossref | GoogleScholarGoogle Scholar |
[12] Callander EJ, Corscadden L, Levesque J-F. Out-of-pocket healthcare expenditure and chronic disease – do Australians forgo care because of the cost? Aust J Prim Health 2017; 23 15–22.
| Out-of-pocket healthcare expenditure and chronic disease – do Australians forgo care because of the cost?Crossref | GoogleScholarGoogle Scholar |
[13] Hibbert P, Hannaford N, Long J, Plumb J, Braithwaite J. Final report: performance indicators used internationally to report publicly on healthcare organisations and local health systems. Sydney: Australian Institute of Health Innovation, University of New South Wales; 2013.
[14] Kisely S, Smith M, Lawrence D, Cox M, Campbell LA, Maaten S. Inequitable access for mentally ill patients to some medically necessary procedures. CMAJ 2007; 176 779–84.
| Inequitable access for mentally ill patients to some medically necessary procedures.Crossref | GoogleScholarGoogle Scholar |
[15] Lawrence D, Kisely S. Review: inequalities in healthcare provision for people with severe mental illness. J Psychopharmacol 2010; 24 61–8.
| Review: inequalities in healthcare provision for people with severe mental illness.Crossref | GoogleScholarGoogle Scholar |
[16] The Royal Australian and New Zealand College of Psychiatrists. The economic cost of serious mental illness and comorbidities in Australia and New Zealand. Melbourne: Royal Australian and New Zealand College of Psychiatrists; 2016.
[17] Lawrence D, Hancock KJ, Kisely S. The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers. BMJ 2013; 346 f2539
| The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers.Crossref | GoogleScholarGoogle Scholar |
[18] Thornicroft G. Physical health disparities and mental illness: the scandal of premature mortality. Br J Psychiatry 2011; 199 441–2.
| Physical health disparities and mental illness: the scandal of premature mortality.Crossref | GoogleScholarGoogle Scholar |
[19] The Commonwealth Fund. 2016 Commonwealth Fund International Health Policy Survey of Adults; 2016. Available at: https://www.commonwealthfund.org/publications/surveys/2016/nov/2016-commonwealth-fund-international-health-policy-survey-adults [verified 6 July 2018].
[20] Australian Bureau of Statistics (ABS). 4364.0.55.001 – National health survey: first results, 2014–15. Canberra: ABS; 2015.
[21] Liu NH, Daumit GL, Dua T, Aquila R, Charlson F, Cuijpers P, Druss B, Dudek K, Freeman M, Fujii C, Gaebel W, Hegerl U, Levav I, Munk Laursen T, Ma H, Maj M, Elena Medina‐Mora M, Nordentoft M, Prabhakaran D, Pratt K, Prince M, Rangaswamy T, Shiers D, Susser E, Thornicroft G, Wahlbeck K, Fekadu Wassie A, Whiteford H, Saxena S. Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas. World Psychiatry 2017; 16 30–40.
| Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas.Crossref | GoogleScholarGoogle Scholar |
[22] Mental Health Commission of NSW. Physical health and mental wellbeing evidence guide. Sydney: Mental Health Commission of NSW; 2016.
[23] Stanley SH, Laugharne JD. linical guidelines for the physical care of mental health consumers: a comprehensive assessment and monitoring package for mental health and primary care clinicians. Aust N Z J Psychiatry 2011; 45 824–9.
| linical guidelines for the physical care of mental health consumers: a comprehensive assessment and monitoring package for mental health and primary care clinicians.Crossref | GoogleScholarGoogle Scholar |
[24] Corscadden L, Levesque JF, Lewis V, Strumpf E, Breton M, Russell G. Factors associated with multiple barriers to access to primary care: an international analysis. Int J Equity Health 2018; 17 28
| Factors associated with multiple barriers to access to primary care: an international analysis.Crossref | GoogleScholarGoogle Scholar |
[25] Department of Health. The fifth national mental health plan (fifth plan) consultation draft. Canberra: Department of Health; 2016.
