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Income-based inequities in access to psychotherapy and other mental health services in Canada and Australia

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  • Bartram, Mary
  • Stewart, Jennifer M.

Abstract

This paper compares income-based inequities in access to psychotherapy and other mental health services in Canada and Australia, two federal parliamentary systems with sharply contrasting responses to high rates of unmet need. Income-based inequity is measured by need-standardized concentration indices, using comparable data from the Canadian Community Health Survey 2011–2012 and the Australian National Survey of Mental Health and Well-Being 2007. The results indicate that utilization of psychologist services is more concentrated at higher income levels (i.e. pro-rich) than the other provider groups in both countries, and may be more pro-rich in Canada than in Australia. While the distribution of unmet need for psychotherapy was expected (as a negative indicator of access) to be more concentrated at lower income levels (i.e. pro-poor) under Canada’s two-tier system, unmet need was not more equitable in Australia despite expanded public insurance coverage. As psychotherapy was made universally affordable for the first time in Australia in 2006, a possible backlog effect may have driven up both service utilization and unmet need, particularly among lower-income Australians. The impact of different Medicare co-payment policies also warrants further exploration.

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  • Bartram, Mary & Stewart, Jennifer M., 2019. "Income-based inequities in access to psychotherapy and other mental health services in Canada and Australia," Health Policy, Elsevier, vol. 123(1), pages 45-50.
    • Handle: RePEc:eee:hepoli:v:123:y:2019:i:1:p:45-50
    DOI: 10.1016/j.healthpol.2018.10.011
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    References listed on IDEAS

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    Cited by:

    1. Arpin, Emmanuelle & de Oliveira, Claire & Siddiqi, Arjumand & Laporte, Audrey, 2023. "The “Long-arm” of chronic conditions in childhood: Evidence from Canada using linked survey-administrative data," Economics & Human Biology, Elsevier, vol. 50(C).
    2. Laura Hirello & Mohammad Habibullah Pulok & Mohammad Hajizadeh, 2022. "Equity in healthcare utilization in Canada’s publicly funded health system: 2000–2014," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(9), pages 1519-1533, December.
    3. Nicole Black & David W. Johnston & Martin Knapp & Michael A. Shields & Gloria H.Y. Wong, 2024. "Horizontal inequity in the use of mental healthcare in Australia," Papers 2024-14, Centre for Health Economics, Monash University.
    4. Md Irteja Islam & Gail M Ormsby & Enamul Kabir & Rasheda Khanam, 2021. "Estimating income-related and area-based inequalities in mental health among nationally representative adolescents in Australia: The concentration index approach," PLOS ONE, Public Library of Science, vol. 16(9), pages 1-14, September.

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