As outlined in table 1.1 of this report, Better Access takes the form of 29 items numbers on the MBS. These reimburse: GPs for preparing a reviewing mental health treatment plans and providing mental health consultations; Consultant Psychiatrists for conducting an initial consultation, and for providing and reviewing a patient assessment and management plan; Clinical Psychologists for providing Psychological Therapy Services; and General Psychologists, and selected Occupational Therapists and Social Workers for providing Focussed Psychological Strategies. The costs of services provided under the Better Access MBS items are reimbursed in part or wholly by Medicare Australia. The relevant provider can either bulk–bill the consumer (by charging the schedule fee and directly billing Medicare Australia), or can bill the consumer an amount above the schedule fee and the consumer can then obtain a rebate up to the level of the schedule fee from Medicare Australia. Medicare pays 100% of the MBS fee for GP consultations and 85% of the MBS fee for specialist consultations out–of–hospital (75% for in–hospital consultations). Where a service is bulk billed, the provider claims only the relevant percentage of the MBS fee from Medicare Australia for the service, thus making the service free to the patient. If the provider does not bulk–bill, then the consumer pays the difference between what the providers’ fee and the MBS rebate. A co–payment is the contribution made by the consumer towards medical treatment. The schedule fees and MBS rebates for Better Access items, as at 31 March 2010, are shown in table 1.1.

The impact of Better Access has been substantial not only in terms of the proportion of the population using these services (see chapter 3), but also in terms of the program costs. Almost than 2.7 million Better Access services were provided in 2007; this grew to more almost 3.8 million services in 2008 (an annual increase of 40.6%) and to more than 4.6 million in 2009 (an annual increase of 23.2%). The total cost of these services to government, in terms of benefits paid, increased from $288.9 million in 2007 to $389.4 million in 2008 (an annual increase of 34.8%), and to $478.1 million in 2009 (an annual increase of 22.8%).

Table 4.1 shows the annual costs associated with all Better Access services provided in 2007, 2008 and 2009. Virtually all services are bulk–billed or attract a non–zero co–payment. For a small percentage of services the patient is billed but with a zero co–payment – these have been classified as services with co–payments. Note that only services for which the consumer contributed a co–payment are included in the calculation of an average co–payment (i.e., it is not the average patient cost incurred across all services). Table 4.1 shows that:

  • More than half of all Better Access services were bulk–billed – 53.6% in 2007, increasing slightly to 56.5% in 2008 and 58.6% in 2009.

  • Approximately 46.4% of services in 2007 involved a co–payment by the consumer. This percentage decreased to 43.5% in 2008 and further to 41.4% in 2009. For services with a co–payment, the average co–payment increased marginally from $34.20 in 2007 to $34.64 in 2008 and $35.74 in 2009.
Top of pageTable 4.2, table 4.3 and table 4.4 profile the annual services and costs of Better Access services according to four Better Access item groups: GP Mental Health Treatment items; Consultant Psychiatry items; Psychological Therapy Services items, and Focussed Psychological Strategies items. These show marked variation between provider groups:
  • The bulk–billing rate is far higher for the GP items than for the all other item groups, however the magnitude of the difference has decreased between 2007 and 2009 as bulk–billing rates for other providers has increased. One factor that may account for the lower rates of bulk–billing rates for allied health providers, compared to GPs, relates to the types of MBS items being claimed. As shown in section 3.5 of this report, the overwhelming majority of allied health services provided are long (i.e., 50+ minute) consultations.

  • Conversely, the co–payment rate is lower for the GP items. Roughly two–thirds of Consultant Psychiatry, Psychological Therapy and Focussed Psychological Strategies items services involve a co–payment.

  • The average co–payment is roughly 2–3 times greater for the Consultant Psychiatry items than all other item groups.
Table 4.5, table 4.6 and table 4.7 profile the annual services and costs of Better Access services according to the various provider types, allowing inspection of co–payment rates for the various types of allied health providers. These show that co–payment rates for general psychologists and social workers were similar, and were lower than those of occupational therapists (57.2%, 56.6% and 73.3% respectively, in 2009). However the average co–payment was higher for general psychologists than for social workers and occupational therapists ($37.26, $31.88 and $28.16, respectively, in 2009).

Changes in patterns of co–payment from 2007 to 2009 were examined, in terms of:
  1. the percentage of services requiring a co–payment, and;
  2. the average co–payment made.
Figure 4.1 shows the percentage of Better Access services attracting a co–payment in each of 2007, 2008 and 2009, broken down by item group and provider type. Figure 4.2 shows the average copayment made for Better Access services in each of 2007, 2008 and 2009, broken down by item group and provider type. Figure 4.1 shows that, for most provider groupings, the percentage of services requiring a co–payment decreased between 2007 and 2009. The average decrease was 10.8% (see table 4.1). The largest decreases have been for services provided by clinical psychologists, general psychologists and social workers. The exception was services provided by occupational therapists, for which the percentage requiring a co–payment has remained steady. Figure 4.2 shows that, for all provider groups except occupational therapists, the average copayment has increased since 2007. However the average increase was only 4.5% (see table 4.1).

Figure 4.1 Percentage of Better Access services for which a co–payment was made by item group, 2007, 2008 and 2009.

Text equivalent below for Figure 4.1 Percentage of Better Access services for which a co–payment was made by item group, 2007, 2008 and 2009.

GP, General Practitioner; CP, Consultant Psychiatrist; ClinPsy, Clinical Psychologist; GenPsy, General Psychologist; OT, Occupational Therapist; SW, Social Worker.

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Text version of Figure 4.1

2007
% of services
2008
% of services
2009
% of services
GP items
8.6
7.7
7.3
CP items
68.0
66.1
63.7
Clin Psy items
73.2
68.1
65.4
FPS items
67.4
61.7
57.4
Gen Psy items
67.3
61.6
57.2
OT items
73.0
71.7
73.3
SW items
68.8
60.7
56.6
All Better Access items
46.4
43.5
41.4

Figure 4.2 Average co–payment for Better Access services by item group, 2007, 2008 and 2009.

Text equivalent below for Figure 4.2 Average co–payment for Better Access services by item group, 2007, 2008 and 2009.

GP, General Practitioner; CP, Consultant Psychiatrist; ClinPsy, Clinical Psychologist; GenPsy, General Psychologist; OT, Occupational Therapist; SW, Social Worker.

Text version of Figure 4.2

2007
Average co-payment ($)
2008
Average co-payment ($)
2009
Average co-payment ($)
GP items
18.35
19.05
20.26
CP items
72.71
76.39
81.74
Clin Psy items
29.54
30.64
32.15
FPS items
35.06
35.68
36.67
Gen Psy items
35.34
36.13
37.26
OT items
30.20
29.11
28.16
SW items
30.82
31.08
31.88
All Better Access items
34.20
34.64
35.74
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Table 4.1 MBS–subsidised Better Access services received, bulk–billing rate, fees charges, benefits paid and average co–payments, 2007, 2008 and 2009

YearTotal Services
N
Bulk-billed services
N
Bulk-billed services
%
Fees charged
$
Benefits paid
$
Services with co-payments
N
Services with co-payments
%
Services with co-payments
Average co-payments ($)a
Total patients
N
2007
2,693,449
1,443,627
53.6
331,614,292
288,870,763
1,249,822
46.4
34.20
710,840
2008
3,786,600
2,138,573
56.5
446,539,711
389,447,563
1,648,027
43.5
34.64
951,454
2009
4,663,981
2,731,146
58.6
547,217,572
478,135,712
1,932,835
41.4
35.74
1,130,384

2007 and 2008 figures have regard to all claims processed up to and including 30 April 2009; 2009 figures have regard to all claims processed up to and including 30 April 2010.
Fees charged, benefits paid, and average copayments are expressed in 2009 dollars.
a Only services for which the consumer contributed a co–payment are included in the calculation of the average co–payment.

Table 4.2 MBS–subsidised Better Access services received, bulk–billing rate, fees charges, benefits paid and average co–payment, by Item group, 2007

Total Services
N
Bulk-billed services
N
Bulk-billed services
%
Fees charged
$
Benefits paid
$
Services with co-payments
N
Services with co-payments
%
Services with co-payments
Average co-payments ($)a
Total patients
N
GP items
1,012,497
925,910
91.4
119,225,281
117,636,222
86,587
8.6
18.35
648,867
CP items
94,590
30,231
32.0
25,901,960
21,222,543
64,359
68.0
72.71
87,947
PTS items
507,367
136,073
26.8
71,707,903
60,739,728
371,294
73.2
29.54
98,612
FPS items
1,078,995
351,413
32.6
114,779,148
89,272,270
727,582
67.4
35.06
226,169

2007 figures have regard to all claims processed up to and including 30 April 2009.
Fees charged, benefits paid, and average copayments are expressed in 2009 dollars.
GP, General practitioner; CP, Consultant psychiatrist; PTS Psychological Therapy Services; FPS, Focussed Psychological Strategies.
a Only services for which the consumer contributed a co–payment are included in the calculation of the average co–payment.

Table 4.3 MBS–subsidised Better Access services received, bulk–billing rate, fees charges, benefits paid and average co–payment, by Item group, 2008

Total Services
N
Bulk-billed services
N
Bulk-billed services
%
Fees charged
$
Benefits paid
$
Services with co-payments
N
Services with co-payments
%
Services with co-payments
Average co-payments ($)a
Total patients
N
GP items
1,375,025
1,269,689
92.3
152,526,591
150,519,438
105,336
7.7
19.05
817,738
CP items
101,678
34,437
33.9
27,812,365
22,676,030
67,241
66.1
76.39
93,736
PTS items
785,174
250,397
31.9
108,649,361
92,264,952
534,777
68.1
30.64
151,587
FPS items
1,524,723
584,050
38.3
157,551,394
123,987,143
940,673
61.7
35.68
312,035

2008 figures have regard to all claims processed up to and including 30 April 2009.
Fees charged, benefits paid, and average copayments are expressed in 2009 dollars.
GP, General practitioner; CP, Consultant Psychiatry; PTS Psychological Therapy Services; FPS, Focussed Psychological Strategies.
a Only services for which the consumer contributed a co–payment are included in the calculation of the average co–payment.

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Table 4.4 MBS–subsidised Better Access services received, bulk–billing rate, fees charges, benefits paid and average co–payment, by Item group, 2009

Total Services
N
Bulk-billed services
N
Bulk-billed services
%
Fees charged
$
Benefits paid
$
Services with co-payments
N
Services with co-payments
%
Services with co-payments
Average co-payments ($)a
Total patients
N
GP items
1,659,534
1,538,270
92.7
182,427,744
179,971,434
121,264
7.3
20.26
971,836
CP items
109,734
39,846
36.3
30,529,663
24,816,904
69,888
63.7
81.74
100,434
PTS items
1,000,129
345,693
34.6
139,410,904
118,370,909
654,436
65.4
32.15
189,418
FPS items
1,894,584
807,337
42.6
194,849,261
154,976,465
1,087,247
57.4
36.67
379,284

2009 figures have regard to all claims processed up to and including 30 April 2010.
Fees charged, benefits paid, and average copayments are expressed in 2009 dollars.
GP, General practitioner; CP, Consultant Psychiatry; PTS Psychological Therapy Services; FPS, Focussed Psychological Strategies.
a Only services for which the consumer contributed a co–payment are included in the calculation of the average co–payment.

Table 4.5 MBS–subsidised Better Access services received, bulk–billing rate, fees charges, benefits paid and average co–payment, by provider type, 2007

Total Services
N
Bulk-billed services
N
Bulk-billed services
%
Fees charged
$
Benefits paid
$
Services with co-payments
N
Services with co-payments
%
Services with co-payments
Average co-payments ($)a
Total patients
N
GP
1,012,497
925,910
91.4
119,225,281
117,636,222
86,587
8.6
18.35
618,867
CP
94,590
30,231
32.0
25,901,960
21,222,543
64,359
68.0
72.71
87,947
ClinPsy
507,367
136,073
26.8
71,707,903
60,739,728
371,294
73.2
29.54
98,612
GenPsy
1,015,656
332,107
32.7
108,657,798
84,503,304
683,549
67.3
35.34
213,963
OT
10,444
2,824
27.0
1,049,111
818,985
7,620
73.0
30.20
2,011
SW
52,895
16,482
31.2
5,072,238
3,949,981
36,413
68.8
30.82
10,918

2007 figures have regard to all claims processed up to and including 30 April 2009.
Fees charged, benefits paid, and average copayments are expressed in 2009 dollars.
GP, General Practitioner; CP, Consultant Psychiatrist; ClinPsy, Clinical Psychologist; GenPsy, General Psychologist; OT, Occupational Therapist; SW, Social Worker.
a Only services for which the consumer contributed a co–payment are included in the calculation of the average co–payment.

Table 4.6 MBS–subsidised Better Access services received, bulk–billing rate, fees charges, benefits paid and average co–payment, by provider type, 2008

Total Services
N
Bulk-billed services
N
Bulk-billed services
%
Fees charged
$
Benefits paid
$
Services with co-payments
N
Services with co-payments
%
Services with co-payments
Average co-payments ($)a
Total patients
N
GP
1,375,025
1,269,689
92.3
152,526,591
150,519,438
105,336
7.7
19.05
817,738
CP
101,678
34,437
33.9
27,812,365
22,676,030
67,241
66.1
76.39
93,736
ClinPsy
785,174
250,397
31.9
108,649,361
92,264,952
534,777
68.1
30.64
151,587
GenPsy
1,400,485
537,534
38.4
146,008,787
114,829,917
862,951
61.6
36.13
289,785
OT
21,193
5,995
28.3
2,099,122
1,656,685
15,198
71.7
29.11
3,701
SW
103,045
40,521
39.3
9,443,485
7,500,541
62,524
60.7
31.08
20,157

2008 figures have regard to all claims processed up to and including 30 April 2009.
Fees charged, benefits paid, and average copayments are expressed in 2009 dollars.
GP, General Practitioner; CP, Consultant Psychiatry; ClinPsy, Clinical Psychologist; GenPsy, General Psychologist; OT, Occupational Therapist; SW, Social Worker.
a Only services for which the consumer contributed a co–payment are included in the calculation of the average co–payment.

Table 4.7 MBS–subsidised Better Access services received, bulk–billing rate, fees charges, benefits paid and average co–payment, by provider type, 2009

Total Services
N
Bulk-billed services
N
Bulk-billed services
%
Fees charged
$
Benefits paid
$
Services with co-payments
N
Services with co-payments
%
Services with co-payments
Average co-payments ($)a
Total patients
N
GP
1,659,534
1,538,270
92.7
182,427,744
179,971,434
121,264
7.3
20.26
971,836
CP
109,734
39,846
36.3
30,529,663
24,816,904
69,888
63.7
81.74
100,434
ClinPsy
1,000,129
345,693
34.6
139,410,904
118,370,909
654,436
65.4
32.15
189,418
GenPsy
1,722,090
737,533
42.8
178,813,409
142,132,370
984,557
57.2
37.26
348,417
OT
30,016
8,027
26.7
2,954,048
2,334,926
21,989
73.3
28.16
5,103
SW
142,478
61,777
43.4
13,081,803
10,509,169
80,701
56.6
31.88
28,276
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2009 figures have regard to all claims processed up to and including 30 April 2010.
Fees charged, benefits paid, and average copayments are expressed in 2009 dollars.
GP, General Practitioner; CP, Consultant Psychiatrist; ClinPsy, Clinical Psychologist; GenPsy, General Psychologist; OT, Occupational Therapist; SW, Social Worker.
a Only services for which the consumer contributed a co–payment are included in the calculation of the average co–payment.