Significant concerns have been voiced in the media about whether Medicare services provided by psychologists under the Better Access to Mental Health Care initiative are accessible to those most in need of financially-supported psychological treatment. These concerns centre around two issues. Firstly, there have been claims that some psychologists have raised their consulting fees since the introduction of the Medicare rebates, thereby increasing out-of-pocket costs to clients and making access to psychological services prohibitive to low income clients. Related to this is the claim that there is a low rate of bulk billing by psychologists providing services under the Better Access initiative. The second issue is the apparent dearth of private providers of psychological services in rural and remote Australia.
In response to these claims, the APS recently conducted a survey of psychologists providing Medicare services under the Better Access initiative to examine two issues related to concerns about accessibility: the location of psychology service providers and the fees being charged for psychological services. The survey investigated the two groups of psychologists who are eligible to provide services under the Medicare initiative - those accredited clinical psychologists providing ‘psychological therapy' services, and psychologists providing ‘Focussed Psychological Strategies' (FPS) services.
The survey involved a series of questions that were either emailed to members or provided as an online survey. A total of 623 responses were received from clinical psychology providers and 812 responses were received from psychology (FPS) providers.
Table 1 presents data on the location of psychology providers across Australia. The results of the survey show that approximately a quarter of both clinical psychology providers (24%) and psychology (FPS) providers (27%) are delivering psychological services in regional and rural areas. The majority of all psychologist Medicare providers (74%) provide services within metropolitan areas, followed by regional (19%) and rural (7%).
Table 2 displays bulk billing patterns of clinical psychologists and psychologists providing FPS services for locations across metropolitan, regional and rural Australia. A significant majority of clinical psychologists (62%) reported that they bulk bill clients, with the highest proportion of bulk billing services (71%) provided in rural areas. In contrast, just under half of psychologists providing FPS services (48%) bulk bill their clients. The highest proportion of bulk billing services provided by these psychologists (60%) being in regional areas.
The survey results revealed that clinical psychologists treating clients under the Better Access initiative charged an average consulting fee of $133 (for the greater than 50 minute service), which was only $4 above the MBS schedule fee. The average highest fee charged by clinical psychologists was $143, an additional $13.60 on top of the MBS schedule fee of $129.40. The survey found that three quarters of clinical psychologists (77%) were charging less than $150 per session and only 13 per cent were charging $160 or more per session for psychological services.
The psychologists providing FPS services reported an average consulting fee of $101, being $13 above the MBS schedule fee. This group's average highest fee charged was $113, an additional $24.80 above the MBS schedule fee of $24.80. Almost a quarter of psychologists providing FPS services (24%) were charging at or below the schedule fee of $88.20, with only 13 per cent charging more than $120 per session for psychological services.
Table 3 shows the average fees and average highest fees charged by psychologists providing services under the Better Access Medicare initiative.
This survey was conducted to obtain data on psychologists providing services under the Better Access initiative in an attempt to address the concerns about the accessibility of services to those most in need of financially-supported psychological treatment. The responses received from psychologist providers were extremely encouraging. The two concerns about access that were addressed by the survey - location of psychology service providers and cost of services - evoked very clear messages. Psychologists, both those providing clinical psychology services and those providing FPS services, are servicing the regional and rural areas of Australia, providing bulk billing, and keeping out-of-pocket expenses for clients to a minimum.