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

Medicare is Australia’s national, compulsory and universal health insurance arrangement. The Commonwealth Government subsidises privately-produced fee-for-service (FFS) medical services. This study provides evidence about whether or not the objectives of Medicare, involving equality of spatial access, are being achieved for private FFS psychiatric services. The following question is answered: are the utilisation rates of private FFS psychiatric services spatially uniform and temporally uniform in Australia under Medicare? The data analysed are a by-product of Medicare and involve quarterly time series of numbers of services by State/Territory. The results show whether, through time and in the presence of the uniform subsidy arrangements, the total quantities of services, and the quantities per 1,000 population, have risen, fallen or remained constant, and whether statistically significant differences occurred between the regions in the utilisation of psychiatric services. In terms of the initial measure of spatial access applied here, no evidence is found of spatial uniformity in these outcomes for private psychiatric service utilisation