The Australian mental health system: An economic overview and some research issues

This article is concerned with the key economic characteristics of Australia's mental health system. First, some brief conceptual and empirical descriptions are provided of Australia's mental health services, both as a total system, and of its two principal components, viz. public psychiatric institutions and private psychiatry services. Expenditures on public psychiatric hospitals clearly demonstrate the effect of deinstitutionalisation. Data from 1984 on private practice psychiatry indicate that per capita utilisation rates peaked in 1996 and have since fallen. Generally, since 1984 gross fees have not risen. However, for both utilisation and fees, there is evidence (of a statistical kind) that there are significant differences between the states of Australia, in these two variables (utilisation and fees). Emphasis is also placed on the economic incentives that arise from health insurance and the heterogeneous nature of mental illness. The effects of these incentives are regarded as by-products of the health insurance mechanism; and another effect, "unmet need" and "met non-need", is a somewhat unique problem of an informational kind. Discussion of many of these issues concludes on a somewhat negative note, e.g. that no empirical results are available to quantify the particular effect that is discussed. This is a manifestation of the lacunae of economic studies of the mental health sector

Measuring inequality: tools and an illustration

BACKGROUND: This paper examines an aspect of the problem of measuring inequality in health services. The measures that are commonly applied can be misleading because such measures obscure the difficulty in obtaining a complete ranking of distributions. The nature of the social welfare function underlying these measures is important. The overall object is to demonstrate that varying implications for the welfare of society result from inequality measures. METHOD: Various tools for measuring a distribution are applied to some illustrative data on four distributions about mental health services. Although these data refer to this one aspect of health, the exercise is of broader relevance than mental health. The summary measures of dispersion conventionally used in empirical work are applied to the data here, such as the standard deviation, the coefficient of variation, the relative mean deviation and the Gini coefficient. Other, less commonly used measures also are applied, such as Theil's Index of Entropy, Atkinson's Measure (using two differing assumptions about the inequality aversion parameter). Lorenz curves are also drawn for these distributions. RESULTS: Distributions are shown to have differing rankings (in terms of which is more equal than another), depending on which measure is applied. CONCLUSION: The scope and content of the literature from the past decade about health inequalities and inequities suggest that the economic literature from the past 100 years about inequality and inequity may have been overlooked, generally speaking, in the health inequalities and inequity literature. An understanding of economic theory and economic method, partly introduced in this article, is helpful in analysing health inequality and inequity

Australian data for the following years have been estimated by linear interpolation: 1961–62, 1962–63, 1964–65, 1965–66, 1967–68, 1968–69 and 1970–71

<p><b>Copyright information:</b></p><p>Taken from "The Australian mental health system: An economic overview and some research issues"</p><p>http://www.ijmhs.com/content/2/1/4</p><p>International Journal of Mental Health Systems 2008;2():4-4.</p><p>Published online 14 May 2008</p><p>PMCID:PMC2459150.</p><p></p

The Australian mental health system: An economic overview and some research issues-1

) The psychiatric services referred to here relate to the aggregate of the Item Numbers listed in the Notes to Table 1.<p><b>Copyright information:</b></p><p>Taken from "The Australian mental health system: An economic overview and some research issues"</p><p>http://www.ijmhs.com/content/2/1/4</p><p>International Journal of Mental Health Systems 2008;2():4-4.</p><p>Published online 14 May 2008</p><p>PMCID:PMC2459150.</p><p></p

Accuracy of official suicide mortality data in Queensland

Objective: The purpose is to answer the following research question: are the time-series data published by the Australian Bureau of Statistics for Queensland statistically the same as those of the Queensland Suicide Register? Method: This question was answered by first modelling statistically, for males and females, the time series suicide data from these two sources for the period of data availability, 1994 to 2007 (14 observations). Fitted values were then derived from the ‘best fit’ equations, after rigorous diagnostic testing. The outliers in these data sets were addressed with pulse dummy variables. Finally, by applying the Wald test to determine whether or not the fitted values are the same, we determined whether, for males and females, these two data sets are the same or different. Results: The study showed that the Queensland suicide rate, based on Queensland Suicide Register data, was greater than that based on Australian Bureau of Statistics data. Further statistical testing showed that the differences between the two data sets are statistically significant for 24 of the 28 pair-wise comparisons. Conclusions: The quality of Australia's official suicide data is affected by various practices in data collection. This study provides a unique test of the accuracy of published suicide data by the Australian Bureau of Statistics. The Queensland Suicide Register's definition of suicide applies a more suicidological, or medical/health, conception of suicide, and applies different practices of coding suicide cases, timing of data collection processes, etc. The study shows that ‘difference’ between the two data sets predominates, and is statistically significant; thus the extent of the under-reporting of suicide is not trivial. Given that official suicide data are used for many purposes, including policy evaluation of suicide prevention programmes, it is suggested that the system used in Queensland should be adopted by the rest of Australia too