The trend in mental health-related mortality rates in Australia 1916-2004: implications for policy

Background: This study determines the trend in mental health-related mortality (defined here as the aggregation of suicide and deaths coded as “mental/behavioural disorders”), and its relative numerical importance, and to argue that this has importance to policy-makers. Its results will have policy relevance because policy-makers have been predominantly concerned with cost-containment, but a re-appraisal of this issue is occurring, and the trade-off between health expenditures and valuable gains in longevity is being emphasised now. This study examines longevity gains from mental health-related interventions, or their absence, at the population level. The study sums mortality data for suicide and mental/behavioural disorders across the relevant ICD codes through time in Australia for the period 1916-2004. There are two measures applied to the mortality rates: the conventional age-standardised headcount; and the age-standardised Potential Years of Life Lost (PYLL), a measure of premature mortality. Mortality rates formed from these data are analysed via comparisons with mortality rates for All Causes, and with circulatory diseases, cancer and motor vehicle accidents, measured by both methods. Results: This study finds the temporal trend in mental health-related mortality rates (which reflects the longevity of people with mental illness) has worsened through time. There are no gains. This trend contrasts with the (known) gains in longevity from All Causes, and the gains from decreases achieved in previously rising mortality rates from circulatory diseases and motor vehicle accidents. Also, PYLL calculation shows mental health-related mortality is a proportionately greater cause of death compared with applying headcount metrics. Conclusions: There are several factors that could reverse this trend. First, improved access to interventions or therapies for mental disorders could decrease the mortality analysed here. Second, it is important also that new efficacious therapies for various mental disorders be developed. Furthermore, it is also important that suicide prevention strategies be implemented, particularly for at-risk groups. To bring the mental health sector into parity with many other parts of the health system will require knowledge of the causative factors that underlie mental disorders, which can, in turn, lead to efficacious therapies. As in any case of a knowledge deficit, what is needed are resources to address that knowledge gap. Conceiving the problem in this way, ie as a knowledge gap, indicates the crucial role of research and development activity. This term implies a concern, not simply with basic research, but also with applied research. It is commonplace in other sectors of the economy to emphasise the trichotomy of invention, innovation and diffusion of new products and processes. This three-fold conception is also relevant to addressing the knowledge gap in the mental health sector

Public Finance and The Size of Government: A Literature Review and Econometric Results for Fiji: Discussion Paper No. 108

This paper analyses current government expenditure in Fiji using annual time series data for the period 1969-1999. Alternative theories of government expenditure are reviewed and a distinction is made between economic/apolitical determinants and institutional/political determinants. Categorising the literature in this way suggests the application of non-nested tests in empirical work. The first step is to estimate the two models separately. All four test statistics for non-nested hypotheses lead to the conclusion of double rejection. A parsimonious comprehensive model, encompassing both economic and institutional variables, is preferred as it passes all diagnostic tests and involves the acceptance conclusion from pairwise non-nested tests

Public Finance and The Size of Government: A Literature\ud Review and Econometric Results for Fiji: Discussion Paper No. 108

This paper analyses current government expenditure in Fiji using annual time series data for\ud the period 1969-1999. Alternative theories of government expenditure are reviewed and a\ud distinction is made between economic/apolitical determinants and institutional/political\ud determinants. Categorising the literature in this way suggests the application of non-nested\ud tests in empirical work. The first step is to estimate the two models separately. All four test\ud statistics for non-nested hypotheses lead to the conclusion of double rejection. A\ud parsimonious comprehensive model, encompassing both economic and institutional variables,\ud is preferred as it passes all diagnostic tests and involves the acceptance conclusion from\ud pairwise non-nested tests

Private psychiatry and Medicare: Regional equality of access in Australia?

Background: Private psychiatric services are produced and consumed on a fee-for-service (FFS) basis in Australia. The Commonwealth Government subsidises these (and all) medical services via Medicare, a universal, comprehensive, tax-financed medical and hospital financing mechanism. A key purpose of Medicare is to improve equality of access to medical services. Aims: To measure the distribution of ‘‘access’’, as measured by utilization, to private FFS psychiatric services at a regional level; and to determine the temporal trend in equality in regional access to these services during the Medicare period. Method: Conventional measures of statistical dispersion and economic inequality (the coefficient of variation, Gini coefficient and the Atkinson measure) are applied to quarterly time-series data on quantities of private psychiatric services for Australia’s regions since 1984. Equations are modelled statistically on the distributional data generated by applying these measures. Lorenz curves are also constructed. Results: The negative sign on the slope coefficients in all estimated equations, i.e., for each measure of the distribution, is statistically significant, but the slope coefficients are nearly zero. Conclusions: These preliminary results suggest relatively intractable movement in alleviating inequality in the private psychiatric services produced and consumed in Australia, at the broad level of the region, during two decades of Medicare subsidies

Prices and subsidies for Australian psychiatric services: a positive economic analysis

The production of specialist psychiatric services in Australia reflects the “mixed” system of public and private production of health services generally. This paper, an exercise in descriptive or positive economics, is concerned only with private production, i.e. those services provided by psychiatrists operating in “private practice” on a fee-for-service basis. It is shown that there is a sharp distinction in Australian institutional arrangements between psychiatric services produced in-hospital and out-of-hospital. The main differences relate to the general coinsurance rates applied, 75 per cent in the former case and 85 per cent in the latter case. In addition out-of-hospital services are subject to a “gap” safety-net provision. Using both algebraic and geometric expositions, the central relationships between gross prices, net prices, schedule fees and subsidies/rebates are illustrated in general, and in various special cases, e.g. where a psychiatrist “direct bills” or “bulk bills” the Health Insurance Commission

The 'Rise and Rise' of New Professional Groups: Mental Health Professions under Medicare

From November 2006, three paramedical professions that provide mental health services - eligible or approved psychologists, social workers and occupational therapists - came within the scope of Medicare. The purpose of this article is to place that historic decision in context, first by examining several key secular trends in psychiatry as a profession, and then by presenting some data on the professional groups newly subsidised under Medicare. The trends in psychiatry give the context of that decision and point to the structural forces that are likely to be associated with the provision of mental health services in Australia