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

Health Policy. 2019 Jan;123(1):45-50. doi: 10.1016/j.healthpol.2018.10.011. Epub 2018 Oct 16.

Abstract

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.

Keywords: Access; Australia; Canada; Equity; Income; Mental health.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Australia
  • Canada
  • Female
  • Health Care Surveys
  • Health Services Accessibility
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Income / statistics & numerical data
  • Male
  • Mental Health Services*
  • Middle Aged
  • Psychotherapy*
  • Young Adult