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

Objective: 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.