Psychologists divided on tiered rebates
CRITICISMS of the federal Government’s scheme for expanded access to psychology treatments under Medicare have exposed divisions among psychologists themselves over the merits of the scheme.
While the peak professional body for psychologists, the Australian Psychological Society, defended the Better Access scheme as ‘‘ an outstanding success in all aspects’’, others say a recent attack on how it is panning out has merit and changes are required.
The debate was sparked by comments by professor Ian Hickie, executive director of the Brain and Mind Research Institute, who was reported in The Weekend Australian and Weekend Health two weeks ago (July 21) as saying the scheme was not encouraging services in outer-metropolitan and rural areas, where they were really needed.
He also said that while the numbers of services being provided under the new arrangements for subsidised psychology services were much higher than expected, there was a real question over quality.
That was because a lower tier of rebate, created for ‘‘ focused psychological strategies’’ which Hickie said were often delivered by
lesser trained’’ psychologists, was being used twice as much as a higher-level rebate accessed by clinical psychologists.
While Hickie’s comment on a dearth of rural services appears supported by some Medicare data, the APS said it had conducted a survey of psychologists and found 24 per cent of them were providing Medicare-funded services outside metropolitan areas.
In addition, the APS said 66 per cent of psychologists surveyed said they were bulkbilling ‘‘ patients in financial need’’, although how financial need was determined was not disclosed. ‘‘ Further findings indicate that of the clinical psychologists working under Medicare, over 75 per cent have been charging less than $140, and over 90 per cent less than $150 for their total hour-long service,’’ the APS said.
The distinction between lesser and better trained psychologists has enraged some in the psychology profession. One professional said ‘‘ excellent to poor counsellors (exist) in both categories’’ and to make ‘‘ a financial distinction in the Medicare rebate on the basis of clinical psychologists and ‘ lesser qualified’ practitioners is a restrictive trade practice that cannot be justified’’.
However, the distinction support from other quarters.
Fremantle clinical psychologist doctor Jill Horton agreed that a ‘‘ second tier of rebates for lesser qualified psychologists and counsellors should not be available’’ and called for national training standards to be introduced for psychologists. ‘‘ This should consist of a minimum of six years’ university training in psychology, two years’ professional supervision and at least five years’ working in the public sector within the profession,’’ Horton said.
She also said that if too many services were being done by the lesser-trained psychologists, then the fact that these patients had first to be referred to the psychologist by a GP or paediatrician suggested ‘‘ the professional groups who are making the referrals would perhaps benefit from more education about the different training levels and qualifications of the different psychology service providers’’.