A time series analysis of Medicare-reimbursed telepsychiatry consultations across Australian states and territories before and after telehealth item expansion: Enabling policy can improve access to care
Restricted accessResearch articleFirst published online January, 2026
A time series analysis of Medicare-reimbursed telepsychiatry consultations across Australian states and territories before and after telehealth item expansion: Enabling policy can improve access to care
We aimed to examine the associations of telepsychiatry consultations with the Medicare Benefits Schedule (MBS) telehealth policy changes (pandemic-related expansion and subsequent consolidation).
Methods
We performed a time series analysis of MBS telepsychiatry usage (January 2016–December 2023) using state/territory-level Medicare panel data. Linear regression analyses with panel-corrected standard error and autocorrelation were performed for telepsychiatry consultations (overall and age and sex subgroups). Telehealth policies, rural psychiatrist availability (rural psychiatrists per 100,000 population) and their interaction were the independent variables. The models were adjusted for pandemic lockdown severity (Stringency Index) and population size.
Results
Telehealth expansion and consolidation were associated with substantial increases in telepsychiatry consultations, with larger increases in the consolidation phase. Given the telehealth policy changes, lower per capita rural psychiatrists were associated with more telepsychiatry consultations. Males and older people (>65 years) showed greater relative consultation increases. Policy change-related telepsychiatry increases varied amongst states and territories.
Discussion
There was sustained telepsychiatry usage when it became more readily available, beyond the direct impact of acute pandemic lockdowns. Telehealth-enabling policies may contribute to fulfilling unmet mental health needs and improving access to psychiatric care amongst Australians. Further in-depth research in this area is needed.
LooiJCLAllisonSBastiampillaiT, et al. Telepsychiatry and face-to-face psychiatric consultations during the first year of the COVID-19 pandemic in Australia: patients being heard and seen. Australas Psychiatry2022; 30: 206–211.
3.
WoonLS-CAllisonSBastiampillaiT, et al.Comparing the trends of MBS telepsychiatry and consultant physician telehealth services from 2017 to 2022: a retrospective study. Australas Psychiatry2024; 32: 431–439.
4.
LooiJCBastiampillaiTPringW, et al. Lessons from billed telepsychiatry in Australia during the COVID-19 pandemic: rapid adaptation to increase specialist psychiatric care. Public Health Res Pract2022; 32: e3242238.
5.
McGillionMSwobodaKJonesS, et al. Auditor-General Report No. 10 2022–23: Expansion of Telehealth Services, Department of Health and Aged Care (Performance Audit). 2023.
6.
LooiJCAllisonSKiselySR, et al. Greatly increased Victorian outpatient private psychiatric care during the COVID-19 pandemic: New MBS-telehealth-item and face-to-face psychiatrist office-based services from April-September 2020. Australas Psychiatry2021; 29: 423–429. 20210413.
7.
SnoswellCLArnautovskaUHaydonHM, et al.Increase in telemental health services on the Medicare Benefits Schedule after the start of the coronavirus pandemic: data from 2019 to 2021. Aust Health Rev2022; 46: 544–549.
8.
SreedharanSMianMGilesS. Mental health attendances in Australia during the COVID-19 pandemic: a telehealth success story?Asia Pac J Public Health2021; 33: 453–455.
HayterCMAllisonSBastiampillaiT, et al.The changing psychiatry workforce in Australia: Still lacking in rural and remote regions. Aust J Rural Health2024; 32: 332–342.
14.
MucicD. WPA Global guidelines for telepsychiatry. Eur Psychiatry2021; 64: S124–S124. 2021/08/13.
15.
MarangunićNGranićA. Technology acceptance model: A literature review from 1986 to 2013. Univers Access Inf Soc2015; 14: 81–95.
16.
ArningKZiefleM. Understanding age differences in PDA acceptance and performance. Comput Hum Behav2007; 23: 2904–2927.
17.
Van VolkomMStapleyJCMalterJ. Use and perception of technology: Sex and generational differences in a community sample. Educ Gerontol2013; 39: 729–740.
18.
HaleTAngristNGoldszmidtR, et al.A global panel database of pandemic policies (Oxford COVID-19 government response tracker). Nat Hum Behav2021; 5: 529–538.
BeckN. Time–Series Cross–Section Methods. In: Box-SteffensmeierJMBradyHECollierD (eds) The Oxford Handbook of Political Methodology. Oxford University Press, 2008.
23.
Rabe-HeskethSSkrondalA. Multilevel and longitudinal modeling using Stata. Fourth ed.Stata Press, 2022.
24.
EdwardsBBarnesRRehillP, et al.Variation in Policy Response to COVID-19 Across Australian States and Territories. 2022.
25.
BeckNKatzJN. What to do (and not to do) with time-series cross-section data. Am Polit Sci Rev1995; 89: 634–647.
26.
BradfordNKCafferyLJSmithAC. Telehealth services in rural and remote Australia: A systematic review of models of care and factors influencing success and sustainability. Rural Remote Health2016; 16: 3808. 20161017.
27.
PetrieKBaldwinPCrawfordJ, et al. The voice of mental health practice in Australia: A mixed-method cross-sectional study of gaps and areas of need. Aust N Z J Public Health2021; 45: 318–324.
28.
SutherlandRHodgeAChanE, et al.Barriers and facilitators: Clinicians’ opinions and experiences of telehealth before and after their use of a telehealth platform for child language assessment. Int J Lang Commun Disord2021; 56: 1263–1277.
29.
MayCFinchTRapleyT. Normalization process theory. In: NilsenPBirkenSA (eds) Handbook on Implementation Science. Edward Elgar Publishing, 2020, pp.144–167.
30.
MayCHarrisonRFinchT, et al.Understanding the normalization of telemedicine services through qualitative evaluation. J Am Med Inform Assoc2003; 10: 596–604.
31.
WilliamsRDoesselD. Equality of spatial access and Medicare: An empirical study of the numbers of private fee-for-service psychiatric services in the Australian states and territories 1984–2001. Australas J Reg Stud2004; 10: 225–253. Journal Article.
32.
RodriguezJAShacharCBatesDW. Digital inclusion as health care – supporting health care equity with digital-infrastructure initiatives. N Engl J Med2022; 386: 1101–1103.
33.
MathewSFittsMSLiddleZ, et al.Telehealth in remote Australia: A supplementary tool or an alternative model of care replacing face-to-face consultations?BMC Health Serv Res2023; 23: 341.
34.
WilliamsCShangD. Telehealth usage among low-income racial and ethnic minority populations during the COVID-19 pandemic: Retrospective observational study. J Med Internet Res2023; 25: e43604. Original Paper 12.5.2023.
35.
ShahDASallDPengW, et al. Exploring the role of telehealth in providing equitable healthcare to the vulnerable patient population during COVID-19. J Telemed Telecare2024; 30: 1047–1050. 1357633X221113711.
36.
SchenkerRBLagunaMCOdishoAY, et al.Are we reaching everyone? A cross-sectional study of telehealth inequity in the COVID-19 pandemic in an urban academic pediatric primary care clinic. Clin Pediatr (Phila)2022; 61: 26–33.
37.
WoonLS-CAllisonSBastiampillaiT, et al.Comparing the trends of MBS telepsychiatry and consultant physician telehealth services from 2017 to 2022: A retrospective study. Australas Psychiatry2024; 32: 431–439.
WoonLS-CMaguirePAReayRE, et al. Medicare-reimbursed psychiatric consultations before and after telehealth expansion in Australia: a time series study [Manuscript submitted for publication]2024.
40.
LooiJCAllisonSBastiampillaiT, et al.Telepsychiatry and face-to-face psychiatric consultations during the first year of the COVID-19 pandemic in Australia: Patients being heard and seen. Australas Psychiatry2022; 30: 206–211.
41.
DaiZSezginGLiJ, et al. Telehealth utilisation in residential aged care facilities during the COVID-19 pandemic: A retrospective cohort study in Australian general practice. J Telemed Telecare2022; 30: 834–841. 1357633X221094406.
42.
WoonLS-CAllisonSBastiampillaiT, et al. Comparison of the out-of-pocket costs of Medicare-funded telepsychiatry and face-to-face consultations: A descriptive study. Australas Psychiatry2024; 32: 204–209. 10398562241237128.
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
