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Better Access and equitable access to clinical psychology services: what do we need to know?

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Critical data on the delivery, outcomes and out-of-pocket expenses of services are lacking

The Australian Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (Better Access) initiative aims to improve access to evidence-based mental health care in the community.1 Providing rebates for private services appears to be improving treatment uptake,2 yet the equity of Better Access has been questioned, with a recent study showing that specialised Better Access mental health services were disproportionately concentrated in affluent areas.3 This effect was particularly visible for clinical psychology services, with more than 2.5 times the volume of these services provided in the most, versus least, affluent areas. Within Better Access, clinical psychology services are intended for “the treatment of patients with complex and/or chronic mental health disorders, quite often with comorbid drug and alcohol problems”.4 As these patients are also more likely to experience financial distress and live in socio-economically disadvantaged areas,5 there is a pressing need to identify why clinical psychology services may be particularly vulnerable to inequitable service distribution.

Cost as a factor in inequitable access to…