Since the inception of Better Access, uptake has been substantial and has grown steadily in subsequent years. Data from Component B show that in 2007, 710,840 Australians (one in every 30) received at least one Better Access service. In 2008, 951,454 (one in every 23) Australians did so, and in 2009, 1,130,384 (one in every 19) did so. Better Access uptake increased by 31.7% between 2007 and 2008 before slowing to 18.7% between 2008 and 2009 (see Table 3). After accounting for some people who received services in more than one year, this equates to 2,016,495 unique individuals who received services over the three year period.

In each year, the vast majority of Better Access consumers (more than 85%) received at least one Better Access service from a GP. This is consistent with the functions of the GP mental health treatment plan and review item numbers (2710b and 2713, respectively) as gateways to further Better Access services. Focussed Psychological Strategies services provided by general psychologists had the next highest uptake rate; just under one third of Better Access consumers received one or more of these services in each year. These were followed by uptake rates for Psychological Therapies services provided by clinical psychologists, then Consultant Psychiatrist services (see Table 4).

Component B also explored the annual costs associated with Better Access services. Table 5 shows that almost than 2.7 million Better Access services were provided in 2007. This increased to 3.8 million services in 2008 and to more than 4.6 million in 2009. 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, and to $478.1 million in 2009.

Table 5 also shows that more than half of Better Access services delivered were bulk-billed. The average co-payment was around $35. The proportion of services that involved a co-payment and the average co-payment varied considerably according to the type of provider who delivered the services. For example, in 2009, only 7% of services delivered under the GP items involved a co-payment by the consumer, whereas up to two thirds of the services delivered under the Consultant Psychiatrist (64%), Psychological Therapy Services (65%) and Focussed Psychological Strategies (57%) items did so. 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. Component B found that the overwhelming majority of allied health services provided are long (i.e., 50+ minute) consultations.

The average co-payment was lowest for GP items ($20 in 2009), somewhat higher for Psychological Therapy Services items ($32) and Focussed Psychological Strategies items ($37), and highest for Consultant psychiatrist items ($82). For services requiring a co-payment, the average co-payment increased between 2007 and 2009 by 4.5%. However, the percentage of services involving a co-payment decreased by 10.8% over the same period. This pattern was evident across all item groups, regardless of provider.

Separate analyses of service-level Medicare data conducted for the Post-Implementation Review of Better Access18 and the Australian Institute of Health and Welfare's annual reports on mental health services19 20 have also shown increasing levels of Better Access service provision over time. So too have independent analyses conducted by other researchers.21-26

Table 3: Persons receiving any Medicare Benefits Schedule-subsidised Better Access services, 2007, 2008 and 2009, Component B

20071
N persons
20071
Rate (per 1,000)2
20081
N persons
20081
Rate (per 1,000)2
20081
Increase since
2007
20091
N persons
20091
Rate (per
1,000)2
20091
Increase since 2008
710,840
33.8
951,454
44.5
31.7%
1,130,384
52.8
18.7%

1. 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.
2. Rate per 1,000 total population.

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Table 4: Persons receiving Medicare Benefits Schedule-subsidised Better Access services by provider type, 2007, 2008 and 2009, Component B1

Provider type20072
N persons
20072
% of persons
20072 Rate
(per 1,000)3
20082
N persons
20082
% of persons
20082 Rate
(per 1,000)3
20092
N persons
20092
% of persons
20092 Rate
(per 1,000)3
General Practitioner
618,867
87.1
29.5
817,738
85.9
38.3
971,836
86.0
45.4
Consultant psychiatrist
87,947
12.4
4.2
93,736
9.9
4.4
100,434
8.9
4.7
Clinical psychologist
98,612
13.9
4.7
151,587
15.9
7.1
189,418
16.8
8.9
General psychologist
213,963
30.1
10.2
289,785
30.5
13.6
348,417
30.8
16.4
Occupational therapist
2,011
0.3
0.1
3,701
0.4
0.2
5,103
0.5
0.2
Social worker
10,918
1.5
0.5
20,157
2.1
1.0
28,276
2.5
1.3

1. The sum of persons receiving services under each item group will be greater than for all Better Access items because a person may receive services from more than one type of provider.
2. 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.
3. Rate per 1,000 total population.

Table 5: MBS-subsidised Better Access services received, bulk-billing rate, fees charges, benefits paid and average co-payment, by Better Access item group, 2007-2009, Component B

Total services
N
Bulk-billed services
N
Bulk-billed services
%
Fees charged2
$
Benefits paid2
$
Services with co-payments
N
Services with co-payments
%
Services with co-payments
Average copayment ($)4
Total patients
N
20071 GP items3
1,012,497
925,910
91.4
119,225,281
117,636,222
86,587
8.6
18.35
618,867
20071 CP items3
94,590
30,231
32.0
5,901,960
21,222,543
64,359
68.0
72.71
87,947
20071 PTS items3
507,367
136,073
26.8
71,707,903
60,739,728
371,294
73.2
29.54
98,612
20071 FPS items3
1,078,995
351,413
32.6
114,779,148
89,272,270
727,582
67.4
35.06
226,169
20071 Total
2,693,449
1,443,627
53.6
331,614,292
288,870,763
1,249,822
46.4
34.20
710,840
20081 GP items3
1,375,025
1,269,689
92.3
152,526,591
150,519,438
105,336
7.7
19.05
817,738
20081 CP items3
101,678
34,437
33.9
27,812,365
22,676,030
67,241
66.1
76.39
93,736
20081 PTS items3
785,174
250,397
31.9
108,649,361
92,264,952
534,777
68.1
30.64
151,587
20081 FPS items3
1,524,723
584,050
38.3
157,551,394
123,987,143
940,673
61.7
35.68
312,035
20081 Total
3,786,600
2,138,573
56.5
446,539,711
389,447,563
1,648,027
43.5
34.64
951,454
20091 GP items3
1,659,534
1,538,270
92.7
182,427,744
179,971,434
121,264
7.3
20.26
971,836
20091 CP items3
109,734
39,846
36.3
30,529,663
24,816,904
69,888
63.7
81.74
100,434
20091 PTS items3
1,000,129
345,693
34.6
139,410,904
118,370,909
654,436
65.4
32.15
189,418
20091 FPS items3
1,894,584
807,337
42.6
194,849,261
154,976,465
1,087,247
57.4
36.67
379,284
20091 Total
4,663,981
2,731,146
58.6
47,217,572
478,135,712
1,932,835
41.4
35.74
1,130,384

1. 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.
2. Fees charged, benefits paid, and average copayments are expressed in 2009 dollars.
3. GP, General practitioner; CP, Consultant Psychiatry; PTS Psychological Therapy Services; FPS, Focussed Psychological Strategies.
4. Only services for which the consumer contributed a co-payment are included in the calculation of the average copayment.

Footnote

b And, from 1 January 2010, MBS item 2702.