A clinical update on managed care implications for Australian psychiatric practice

Health economics-informed planning of psychiatric care: A primer and curriculum framework for psychiatrists

OBJECTIVE

Contemporary medical education lacks a strong focus on health economics which guides major decisions in private and public health services. We briefly outline the rationale, guiding principles, main analytic methods, and a suggested framework for health economics education in psychiatry.

CONCLUSIONS

Health economics aims to improve the efficiency of healthcare. Some analytic methods can be harnessed by psychiatrists to better plan clinical care. Health economic methods will also assist psychiatrists in translating their expertise and clinical priorities more effectively to policy-makers, governments, and private insurers motivated by economic reasoning.

Commentary on the private practice implications of the Deed of Settlement in the Honeysuckle Health - NIB Australian-Competition-Tribunal-hearing

OBJECTIVE

To provide a commentary on the implications of the Deed of Settlement in the Honeysuckle Health - nib Australian-Competition-Tribunal Hearing. This hearing has major implications in relation to the potential for a single dominant private-health-insurance buying-group to contract for medical-purchaser-provider-agreements that might limit the clinical autonomy of patients and psychiatrists.

CONCLUSIONS

The Australian Competition and Consumer Commission (ACCC) authorised the formation of a joint buying-group for private-health-insurers in 2021 to provide collective contracting and related services to private-health-insurers and other healthcare-payers. A consequent legal challenge resulted in a Deed of Settlement on 18 July 2022 that for 5 years preserves doctor-patient autonomy in clinical decision-making, the medical gaps scheme, the transparency of contractual arrangements, and if clinical data of those insured are collected by HH-nib, it must be with the full informed consent of patients. However, there remain options for private-health-insurers to apply for formation of new buying-groups, as well as to collect data and profile the general public and insured patients using online programs. Vigilance on private-health-insurer buying-groups, and the potential for US-style managed-care is warranted.

The Consortium of Australian Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA): Aims, model, outputs, and implications for clinical academic advocacy

OBJECTIVE

We describe an independent model of clinical academic mental health services research that is able to provide synthesised views for medico-political organisations that are engaged in advocacy for national and state evidence-based policy and planning of mental healthcare.

CONCLUSIONS

CAPIPRA focuses on independent research and policy analysis using publicly available datasets on population mental health at national and state/territory levels, published in international and national peer-reviewed journals (>50 papers since 2019). We partner with medico-political organisations in evidence-based advocacy across a wide range of issues.

Private psychiatric hospital care in Australia: a descriptive analysis of casemix and outcomes

OBJECTIVE

To provide a rapid clinical update on casemix, average length of stay, and the effectiveness of Australian private psychiatric hospitals.

METHODS

We conducted a descriptive analysis of the publicly available patient data from the Australian Private Hospitals Association Private Psychiatric Hospitals Data Reporting and Analysis Service website, from 2015-2016 to 2019-2020. This was compared with corresponding reporting on public and private hospitals from the Australian Institute of Health and Welfare, and Australian Mental Health Outcomes and Classification Network.

RESULTS

In 2019-2020, there were 72 private psychiatric hospitals in Australia with 3582 acute beds. There were 42,942 inpatients with 1,286,470 days of care, and a mean length of stay 19.6 days (SD 13.9) for the financial year 2019-2020. The main diagnoses were major affective and other mood disorders (49%), and alcohol and other substance abuse disorders (21%). Clinician-rated outcome measures, that is, the HoNOS, showed an improvement effect size of 1.64, while the patient-rated MHQ-14 showed an improvement effect size of 1.18. Results are similar for previous years.

CONCLUSIONS

Private psychiatric hospitals provide substantial, effective psychiatric care.