Evaluation of the Better Access to Psychiatrists, Psychologists and GPs through the Medicare Benefits Schedule initiative: component B: an analysis of Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) administrative data

9.4 What is the relationship between Better Access uptake and demand for non-Better Access mental health MBS services at a divisional level?

Page last updated: August 2010

To examine the relationship between Better Access uptake and the use of non–Better Access mental health MBS items, analyses focused on the period since the introduction of Better Access. Specifically, analyses were restricted to 2008 data (the most recent data available for non–Better Access mental health MBS items), as these were considered more likely to be representative of established service use patterns. Figure 9.7 and figure 9.8 show the patterns of uptake of Better Access and non–Better Access MBS items across all 113 Divisions of General Practice, for persons and services, respectively.

Table 9.4 shows the summary statistics for non–Better Access mental health MBS items and Better Access uptake for the 113 Divisions of General Practice in Australia in 2008. The mean rate of persons using non–Better Access mental health MBS items per Division was 10.2 per 1,000 total population, with a range of 0.9 to 30.5 per 1,000. This is, on average, around one–quarter the rate of persons using Better Access items (mean per Division of 41.3 per 1,000 total population). The mean rate of non–Better Access mental health MBS items used per Division was 70.3 per 1,000 total population, with a range of 2.7 to 317.7 per 1,000. This is, on average, around half the rate of persons using Better Access items (mean per Division of 156.5 per 1,000 total population).

The relationship between the uptake of non–Better Access mental health MBS items and Better Access items using negative binomial regression analyses (see chapter 2 for further information) was examined in order to quantify the effect of Better Access uptake on non–Better Access item uptake within Divisions. The first model used total persons using non–Better Access MBS mental health items in the Division as the dependent variable, and adjusted for the size of the population in each stratum of the dataset by incorporating the logarithm of the population size as an offset term. The main predictor was the rate of Better Access users (per 1,000) in the Division. The second model used total non–Better Access MBS mental health services in the Division as the dependent variable, and adjusted for the size of the population in each stratum of the dataset by incorporating the logarithm of the population size as an offset term. The main predictor was the rate of Better Access services used (per 1,000) in the Division. Consideration was given to controlling for GP supply in each Division, using the proportion of full–time weighted equivalent GPs in the Division (GP FWE). However, the relatively high correlation between GP FWE and Better Access population uptake rate (r = 0.580; P < 0.001) precluded this.

Table 9.5 and table 9.6 present the results of the regression analyses. These show that Divisions with relatively higher rates of persons using Better Access items also have relatively higher rates of persons using non–Better Access mental health MBS items (table 9.5). The same was true for the relationship between Better Access and non–Better Access services used (table 9.6).Top of page

Figure 9.7 Persons using Better Access and non–Better Access MBS items, 2008 (rate per 1,000 population), across 113 Divisions of General Practice

Text equivalent below for Figure 9.7 Persons using Better Access and non–Better Access MBS items, 2008 (rate per 1,000 population), across 113 Divisions of General Practice

Text version of Figure 9.7

Figure 9.7 shows two graphs. The first graph shows persons using Better Access MBS items (rate per 1,000 population) for each of the 113 Divisions of General Practice, in ascending order. The usage ranges steadily from approximately 12 persons per 1,000 population at the low end to approximately 76 persons per 1,000 population at the high end.

The second graph shows persons using other mental health MBS items (rate per 1,000 population) for each of the 113 Divisions, in the same order as the first graph.

Comparing the two graphs shows that Divisions with a higher rate of people using Better Access MBS items will tend to have higher rate of people using other mental health MBS items.
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Figure 9.8 Total Better Access and non–Better Access MBS items used, 2008 (rate per 1,000 population), across 113 Divisions of General Practice

Text equivalent below for Figure 9.8 Total Better Access and non–Better Access MBS items used, 2008 (rate per 1,000 population), across 113 Divisions of General Practice

Text version of Figure 9.8

Figure 9.8 shows two graphs. The first graph shows total Better Access services used (rate per 1,000 population) for each of the 113 Divisions of General Practice, in ascending order. The usage ranges fairly steadily from approximately 24 services used per 1,000 population at the low end to approximately 400 services used per 1,000 population at the high end.

The second graph shows total other mental health MBS items used (rate per 1,000 population) for each of the 113 Divisions, in the same order as the first graph.

Comparing the two graphs shows that Divisions with a higher usage of Better Access services will tend to have higher usage of other mental health MBS items.
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Table 9.4 Summary statistics for non–Better Access mental health MBS items and Better Access uptake in 113 Divisions of General Practice in Australia, 2008

Division level measuresRangeMeanSD
Persons using non-Better Access mental health MBS items (per 1,000)
0.9-30.5
10.2
5.9
Non-Better Access mental health MBS items used (per 1,000)
2.7-317.7
70.3
59.4
Better Access users (per 1,000)
12.1-75.7
41.3
11.9
Better Access services used (per 1,000)
23.6-398.1
156.5
67.9

Data have regard to all claims processed up to and including 30 April 2009.
SD, standard deviation.

Table 9.5 Negative binomial regression estimates of rate ratios with 95% CIs for persons using any non–Better Access mental health MBS item, 2008

Rate ratio95% CIP
Better Access users (per 1,000) in Division
1.039
1.030-1.047
<0.001

Table 9.6 Negative binomial regression estimates of rate ratios with 95% CIs for total non–Better Access mental health MBS items used, 2008

Rate ratio95% CIP
Better Access services used (per 1,000) in Division
1.010
1.009-1.012
<0.001