Psy­chol­o­gists di­vided on tiered re­bates

The Weekend Australian - Travel - - Health - Adam Cress­well Health ed­i­tor

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’’.

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