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

Introduction: Telepsychiatry 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. 

Methods: We 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. 

Results: In 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. 

Discussion: While 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.