Private Psychiatry as funded through medicare considered in terms of social equity

Background: The RANZCP code of ethics, point 11.1 reads: ‘Psychiatrists shall be prepared to contribute to improving mental health services and promoting the just allocation of health resources for patients with emotional problems or psychiatric disorders’. The latest National Mental Health Report, reporting data for 2010–2011, found that the Commonwealth Government supplied $852 million in Medical Benefits Schedule (MBS) reimbursements to support mental health services, comprising 12.4% of all Government spending for mental health. Concern has been expressed through the years about the justice of distribution of these resources. Generally, research tends to indicate that psychiatric morbidity and needs for care are higher in urban areas with socio-economic disadvantage while the funding dynamics of the MBS may favour areas with greater socio-economic advantage.

Objectives: To provide information on the geographic distribution of use of mental health-specific MBS items by postcode of residence analysed with consideration of principles of social justice.

Methods: This team, through a Freedom of Information request, gained access to four years (2007–2011) of national Medicare data on mental health items as provided by postcode of residence. Social equity of individual medical MBS items, for psychiatrists and also GPs, were quantitatively assessed using a concentration index approach.

Findings: Some heavily used psychiatry consultation items in this analysis show inequitable properties while GP items and psychiatrists provision of shared care planning perform better on this measure.

Conclusions: The findings will be considered in the context of theories of social justice, and challenges for the ethics of psychiatry considered.