Comparison of the out-of-pocket costs of Medicare-funded telepsychiatry and face-to-face consultations: A descriptive study

OBJECTIVE

Telepsychiatry items in the Australian Medicare Benefits Schedule (MBS) were expanded following the COVID-19 pandemic. However, their out-of-pocket costs have not been examined. We describe and compare patient out-of-pocket payments for face-to-face and telepsychiatry (videoconferencing and telephone) MBS items for outpatient psychiatric services to understand the differential out-of-pocket cost burden for patients across these modalities.

METHODS

out-of-pocket cost information was obtained from the Medical Costs Finder website, which extracted data from Services Australia's Medicare claims data in 2021-2022. Cost information for corresponding face-to-face, video, and telephone MBS items for outpatient psychiatric services was compared, including (1) Median specialist fees; (2) Median out-of-pocket payments; (3) Medicare reimbursement amounts; and (4) Proportions of patients subject to out-of-pocket fees.

RESULTS

Medicare reimbursements are identical for all comparable face-to-face and telepsychiatry items. Specialist fees for comparable items varied across face-to-face to telehealth options, with resulting differences in out-of-pocket costs. For video items, higher proportions of patients were not bulk-billed, with greater out-of-pocket costs than face-to-face items. However, the opposite was true for telephone items compared with face-to-face items.

CONCLUSIONS

Initial cost analyses of MBS telepsychiatry items indicate that telephone consultations incur the lowest out-of-pocket costs, followed by face-to-face and video consultations.

Adult Attention Deficit Hyperactivity Disorder in a Malaysian Forensic Mental Hospital: a Cross-sectional Study

OBJECTIVE

To determine the prevalence of adult attention deficit hyperactivity disorder (ADHD) and comorbid mental disorders in a Malaysian forensic mental hospital.

METHODS

All adult patients admitted to the forensic wards who were able to understand Malay or English language and give written informed consent were included. Participants were assessed using the Conners Adult Attention-Deficit Diagnostic Interview for DSM-IV (for presence of adult ADHD and a history of childhood ADHD) and the Mini International Neuropsychiatric Interview (for psychiatric comorbidities). Sociodemographic and offence-related data were also collected.

RESULTS

Of 199 patients admitted, 120 were included for analysis. The mean age of participants was 36.3 years. 94.2% were men. 81.7% were single, divorced, or separated. 25% had a history of childhood ADHD. The prevalence of adult ADHD was 15.8%. The persistence rate was 63%. Among the 19 participants with adult ADHD, the most common psychiatric comorbidities were substance dependence (68.4%), lifetime depression (63.2%), and generalised anxiety disorder (47.4%). Compared with participants without ADHD, participants with adult ADHD were less likely to be married (0% vs 21.8%, p = 0.022) and more likely to have alcohol abuse (15.8% vs 2%, p = 0.028), lifetime manic/hypomanic episodes (42.1% vs 7.9%, p = 0.001), and generalised anxiety disorder (47.4% vs 19.8%, p = 0.017), and were of younger age at first offence (21.8 years vs 26.9 years, p = 0.021).

CONCLUSIONS

Adult ADHD is common in a Malaysian forensic mental hospital and is associated with unmarried status, alcohol abuse, lifetime manic/hypomanic episodes, generalised anxiety disorder, and younger age at first offence.