The telepsychiatry paradox: Extended access and emerging inequalities in Medicare-reimbursed outpatient psychiatric services

Abstract

The permanent consolidation of Medicare-reimbursed telepsychiatry in Australia has profoundly transformed mental healthcare delivery, successfully widening access for historically underserved populations. However, this rapid shift has precipitated unintended consequences, including a proliferation of one-off video assessments – particularly for attention-deficit hyperactivity disorder (ADHD) among younger people – and soaring out-of-pocket costs disproportionately affecting rural populations. Under-regulated market forces may threaten health equity and continuity of care. To safeguard long-term sustainability, policymakers should consider appropriate clinical frameworks, regulation of telehealth-only providers, and the restructuring of financial incentives to support a balanced, hybrid approach to psychiatric care.