The Department of Health and Ageing (DoHA) engaged a number of external consultants to assist with the Evaluation of the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (Better Access) initiative. The evaluation was undertaken to assess the accessibility, appropriateness and effectiveness of primary mental health care provided to people with diagnosed mental health disorders under the Better Access initiative.
DoHA has adopted a modular approach to the implementation of the evaluation, with six components each contributing to the summative evaluation (see Table 1 below).
KPMG was contracted to undertake Component D of the evaluation – Stakeholder Consultation. Component D involved the design and establishment, collection and reporting of information from a range of stakeholders, including peak professional organisations and consumer and carer organisations with an interest in the Better Access initiative.
The objective of the stakeholder consultation component was to develop an understanding of the:
- perceived benefits and experiences of stakeholders in relation to access, appropriateness and effectiveness of the services;
- impact of education and training activities undertaken as part of the Better Access initiative on existing practices and the treatment of patients; and
- interaction between the Better Access initiative and other related initiatives.
Table 1 – Components of the Evaluation of the Better Access initiative
Impact on health system
Skilled, knowledgeable, integrated workforce
A: A study of consumers & their outcomes
B: Analysis of MBS and PBS data
C: Analysis of allied health workforce supply & distribution
D: Stakeholder consultation
E: Evaluation of major education and training projects
F: Analysis of Second National Survey of Mental Health and Wellbeing
2.1 Detailed evaluation criteriaPrior to KPMG's engagement, DoHA identified 16 key evaluation questions to be explored through the consultation component. Our approach has grouped these questions into six key domains. These include:
- service accessibility;
- service appropriateness;
- service effectiveness;
- the system of mental health care;
- the level of skill, knowledge and integration within the mental health workforce; and
- issues informing the summative evaluation.
2.1.1 Service accessibility
- To what extent has the Better Access initiative provided access to mental health services for people with mental health disorders? Across all of Australia? Across all age groups?
- To what extent has the Better Access initiative provided access to affordable care?
- To what extent has the Better Access initiative provided equitable access to populations in need (in particular people living in rural and remote areas, children and young people, older persons, Aboriginal and Torres Strait Islander people, and people from culturally and linguistically diverse backgrounds)?
2.1.2 Service appropriateness
- To what extent has the Better Access initiative provided evidence-based mental health care to people with mental health disorders?
- To what extent has the Better Access initiative provided services that match client needs and expectations?
2.1.3 Service effectiveness
- To what extent has the Better Access initiative improved health outcomes for people with a mental health disorder?
2.1.4 Mental health care system
- To what extent has the Better Access initiative impacted on the supply and distribution of the psychologist, social worker and occupational therapist workforce?
- How has the Better Access initiative interacted with other related programs/initiatives, including the Better Outcomes in Mental Health Program and the More Allied Health Services Program?
2.1.5 Skilled, knowledgeable, integrated workforce
- To what extent has the Better Access initiative provided interdisciplinary primary mental health care for people with mental disorders?
- Are professionals aware of how to access appropriate primary mental health care training?
- Are professionals accessing appropriate education and training (for example multidisciplinary or profession specific training)?
2.1.6 Informing the summative evaluationTo inform these summative evaluation questions, the consultation process will also focus on the following additional questions / issues:
- What are the characteristics, including clinical characteristics, of consumers receiving Medicare rebateable Better Access mental health services?
- Are professionals, consumers and carers aware of the Better Access initiative?
- Has the Better Access initiative impacted on the use of medications prescribed for the treatment of mental disorders, in particular anti-depressants?
- Has the introduction of the Better Access initiative changed how and where professionals practice (for example, movement to another location, change from public to private sector, or change in the mix of public and private sector work)?
- Are there any unintended consequences for stakeholders due to the introduction of the Better Access initiative?