Register      Login
Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
EDITORIAL

Is cost a barrier to general practice for Australians with mental illness?

Brendan Varden A and Patrick Bolton https://orcid.org/0000-0002-3401-553X B C *
+ Author Affiliations
- Author Affiliations

A Community Mental Health, Eastern Suburbs Mental Health Service, Prince of Wales Hospital, High Street, Randwick, NSW 2031, Australia.

B Eastern Suburbs Mental Health Service, Prince of Wales Hospital, High Street, Randwick, NSW 2031, Australia.

C Centre for Primary Health Care and Equity, University of NSW, NSW, Australia.


Australian Health Review 48(4) 340-341 https://doi.org/10.1071/AH24167
Submitted: 26 June 2024  Accepted: 27 June 2024  Published: 26 July 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.

Abstract

What is known about the topic? Cost is thought to be a barrier to access to primary care for people with mental illness. What does this paper add? Nearly three-quarters of clients of one mental health services do not report cost to be a barrier to primary care. What are the implications for practitioners? Efforts to help people with mental illness engage in primary care may be best directed towards areas other than the cost of access.

Cost is a barrier to access to general practice care in Australia.1 Clients of mental health services face a physical health burden that exceeds that of the general population and so have a greater need for primary health care services.2,3 Cost is a barrier to primary care for this population.

The Eastern Suburbs Mental Health Service (ESMHS), a tertiary mental health service in inner metropolitan Sydney, facilitates access to general practice (GP) care for its clients to mitigate their physical health risk. The service has 574 clients. The service experienced increased difficulty accessing GP services for clients in 2023, thought to be due to a fall in bulk-billing rates and associated rising costs for general practice care, a view reflected in the local media.4 The overall rate bulk billing for New South Wales (NSW) was 82.3%.5

An audit of ESMHS clients was conducted to assess the extent to which cost was a barrier to client access to GP care. Case managers were asked to survey their clients about whether their GP bulk-billed them and cost was a barrier to access.

Responses were obtained from 123 clients (21.4% of the total). Results are shown in Table 1. Overall, 87% of respondents were bulk-billed and cost was an issue for 32%.

Table 1.Proportion of respondents in each subgroup.

Bulk-billedNot bulk-billedUnsure if bulk-billedTotal
Cost not an issue74 (60.2%)2 (1.6%)076 (62.6%)
Cost an issue33 (26.8%)5 (4.1%)2 (1.6%)40 (31.7%)
Unsure01 (0.8%)6 (4.9%)7 (5.7%)
Total107 (87.0%)8 (6.5%)8 (6.5%)123 (100%)

Clients of tertiary mental health services are likely to be among the most mentally ill Australians. Clients who did not provide responses may be particularly disorganised and so challenged to access general practice.

The cost of accessing general practice was an issue for a minority of respondents, and bulk-billed services were widely accessed, more than for the general NSW population. These results do not support a hypothesis that cost is a barrier to access to general practice by clients of ESMHS.

Data availability

Data sharing is not applicable as no new data were generated or analysed during this study.

Disclaimer

The views expressed in this publication are those of the author(s) and do not necessarily represent those of, and should not be attributed to the publisher, the journal owner or CSIRO.

Conflicts of interest

The authors declare no conflicts of interest.

Declaration of funding

This research did not receive any specific funding.

References

Angeles MR, Crosland P, Hensher M. Challenges for Medicare and universal health care in Australia since 2000. Med J Aust 2023; 218(7): 322-329.
| Crossref | Google Scholar | PubMed |

Liu NH, Daumit GL, Dua T, Aquila R, Charlson F, Cuijpers P, et al. 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(1): 30-40.
| Crossref | Google Scholar | PubMed |

Firth J, Siddiqi N, Koyanagi A, Siskind D, Rosenbaum S, Galletly C, et al. The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. Lancet Psychiatry 2019; 6(8): 675-712.
| Crossref | Google Scholar | PubMed |

Chrysantos N. Cost of an average doctor’s appointment up $10 in one year: GPs. Sydney Morning Herald; 15 November 2023. Available at https://www.smh.com.au/politics/federal/cost-of-an-average-doctor-s-appointment-up-10-in-one-year-gps-20231113-p5ejnx.html [cited 15 May 2024].

Butler M. Bulk billing on the rise. Available at https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/bulk-billing-on-the-rise [cited 15 May 2024].