The out-of-pocket costs of Medicare-reimbursed telepsychiatry consultations since telehealth expansion in Australia: An administrative data linkage analysis

IntroductionTelepsychiatry has been widely adopted following changes to the Medicare Benefits Schedule (MBS) telehealth policy. This study aimed to examine the effect of telehealth policy changes on the out-of-pocket costs of MBS-subsidised psychiatric consultations.MethodsWe extracted records of relevant face-to-face, video, and telephone consultations from linked MBS claims data, Pharmaceutical Benefits Schedule data (2017-2023) and the 2021 Census data. For each consultation mode, we calculated the average monthly bulk-billing rate and average fee gap for non-bulk-billed consultations. Multivariate regression analyses were conducted to examine the determinants of bulk-billing and the fee gap.ResultsIn total, 13,507,907 consultations involving 1,234,328 unique individuals were analysed. The average bulk-billing rate was 50.9%, decreasing over time. Fee gaps increased across all consultation modes. Face-to-face consultations were generally less likely to be bulk-billed and incurred higher fee gaps than other modes. Over successive policy periods, video consultations had an increasingly lower likelihood of bulk-billing and were associated with higher fee gaps. Patients in rural and remote areas were likely to bear greater out-of-pocket costs, including for video consultations. Attention Deficit Hyperactivity Disorder (ADHD) prescription-related consultations were associated with lower bulk-billing rates and higher fee gaps, especially in the video mode.DiscussionWhile the expansion of telepsychiatry increased service availability, it did not consistently reduce the financial burden of psychiatric care, especially for rural and remote Australians. The higher out-of-pocket costs associated with ADHD prescription-related consultations warrant closer policy attention.