Adult mental health needs and expenditure in Australia.
BACKGROUND
Relatively little international work has examined whether mental health resource allocation matches need. This study aimed to determine whether adult mental health resources in Australia are being distributed equitably.


METHODS
Individual measures of need were extrapolated to Australian Areas, and Area-based proxies of need were considered. Particular attention was paid to the prevalence of mental health problems, since this is arguably the most objective measure of need. The extent to which these measures predicted public sector, private sector and total adult mental health expenditure at an Area level was examined.


RESULTS
In the public sector, 41.6% of expenditure variation was explained by the prevalence of affective disorders, personality disorders, cognitive impairment and psychosis, as well as the Area's level of economic resources and State/Territory effects. In the private sector, 72.4% of expenditure variation was explained by service use and State/Territory effects (with an alternative model incorporating service use and State/Territory supply of private psychiatrists explaining 69.4% of expenditure variation). A relatively high proportion (58.7%) of total expenditure variation could be explained by service utilisation and State/Territory effects.


CONCLUSIONS
For services to be delivered equitably, the majority of variation in expenditure would have to be accounted for by appropriate measures of need. The best model for public sector expenditure included an appropriate measure of need but had relatively poor explanatory power. The models for private sector and total expenditure had greater explanatory power, but relied on less appropriate measures of need. It is concluded that mental health services in Australia are not yet being delivered equitably.
Burgess
Philip
P
Mental Health Services Research, The University of Queensland, Queensland Centre for Mental Health Research The Park--Centre for Mental Health, Wacol Queensland 4076, Australia. p.burgess@uq.edu.au
Pirkis
Jane
J
Buckingham
Bill
B
Burns
Jane
J
Eagar
Kathy
K
Eckstein
Gary
G
D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000191:economics* / Q000453:epidemiology; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data / Q000600:supply & distribution*; D008875:Middle Aged; D017059:Models, Econometric; D015995:Prevalence; D017149:Private Sector / Q000191:economics; D017150:Public Sector / Q000191:economics; D040841:Resource Allocation