Suchergebnisse

OBJECTIVE: Provincial and territorial governments are considering how best to improve access to psychotherapy from the current patchwork of programmes. To achieve the best value for money, new funding needs to reach a wider population rather than simply replacing services funded through insurance benefits. We considered lessons for Canada from the relative uptake of private insurance and public funding for allied health psychotherapy in Australia. METHOD: We analysed published administrative claims data from 2003–2004 to 2014–2015 on Australian privately insured psychologist services, publicly insured psychotherapy under the 'Better Access' initiative, and public grant funding for psychotherapy through the 'Access to Allied Psychological Services' programme. Utilisation was compared to the prevalence of mental disorders and treatment rates in the 2007 National Survey of Mental Health and Wellbeing. RESULTS: The introduction of public funding for psychotherapy led to a 52.1% reduction in private insurance claims. Costs per session were more than double under private insurance and likely contributed to individuals with private coverage choosing to instead access public programmes. However, despite substantial community unmet need, we estimate just 0.4% of the population made private insurance claims in the 2006–2007 period. By contrast, from its introduction, growth in the utilisation of Better Access quickly dwarfed other programmes and led to significantly increased community access to treatment. CONCLUSIONS: Although insurance in Canada is sponsored by employers, psychology claims also appear surprisingly low, and unmet need similarly high. Careful consideration will be needed in designing publicly funded psychotherapy programmes to prepare for the high demand while minimizing reductions in private insurance claims.

In 2017, the federal Liberal government confirmed the new Canadian Health Accord, which included a targeted transfer of $6B over ten years to the provinces and territories to improve access to home and community care services. Although there were previous federal initiatives aimed at enhancing home and community care services, challenges remain. Many Canadians cannot access home care, and a high burden of care is placed on formal and informal caregivers. These challenges partly stem from an unregulated home care sector and a societal undervaluing of the caregiving role. In 2016, federal, provincial, and territorial governments met and established home and community care as a Canadian health priority. Funding was agreed to in principle from 2016 to 2017 and finalized from 2017 to 2019 through a series of bilateral agreements. The targeted transfer appears to be boosting investments in the home care sector and fostering collaboration across jurisdictions. However, it is unclear whether there have been improvements in access to home and community care. En 2017, le gouvernement libéral fédéral a confirmé le nouvel Accord canadien sur la santé qui comprenait un transfert ciblé de 6 milliards de dollars sur 10 ans aux provinces et aux territoires pour améliorer l'accès aux services de soins à domicile et en milieu communautaire. Bien qu'il y ait eu des initiatives fédérales antérieures visant à améliorer les services de soins à domicile et en milieu communautaire, des problèmes subsistent : de nombreux Canadiens ne sont pas en mesure d'accéder aux soins à domicile et le fardeau des soins pour les proches aidants est élevé. Ces problèmes découlent en partie d'un secteur de soins à domicile non réglementé et d'une sous-valorisation sociétale de l'importance des services prodigués par les aidants et du fardeau qu'ils représentent. En 2016, les gouvernements fédéral, provinciaux et territoriaux ont convenu d'établir les soins à domicile et en milieu communautaire comme une priorité de santé au Canada. Cependant, il a fallu attendre jusqu'en 2019 pour la conclusion de tous les accords bilatéraux de financement. Un an plus tard, ce transfert ciblé semble avoir réussi à stimuler les investissements dans le secteur des soins à domicile et à favoriser la collaboration entre les juridictions. Cependant, il n'est pas encore possible de déceler s'il y a eu des améliorations dans l'accès aux soins à domicile et dans la communauté.

Background: Scarce are the studies focusing on initiation of new mental health service use (MHSU) and distinguishing individuals who have sought services but have been unsuccessful in accessing these. Aims: Assessing the factors associated with initiating new MHSU as compared to no MHSU due to self-reported no need, no MHSU due to health system and personal barriers and MHSU using resources already in place. Methods: The sample included participants ( n = 16,435) in the five established regional cohorts of the Canadian Partnership for Tomorrow's Health (CanPath) who responded to the CanPath COVID-19 health surveys (May–December 2020 and January–June 2021). Multinomial regression analyses were carried out to study MHSU since the pandemic (March 2020) as a function of predisposing, enabling and need factors. Analyses were carried out in the overall sample and restricted to those with moderate and severe symptoms (MSS) of depression and/or anxiety ( n = 2,237). Results: In individuals with MSS of depression and/or anxiety, 14.4% reported initiating new MHSU, 22.0% had no MHSU due to barriers and personal reasons and 36.7% had no MHSU due to self-reported no need. Age, living alone, lower income, a decrease in income during the pandemic and health professional status were associated with MHSU. Younger adults were more likely to initiate MHSU during the pandemic than older adults who reported not being comfortable to seek mental health care or self-reported no need. Individuals living alone and with lower income were more likely to report not being able to find an appointment for mental health care. Conclusions: Awareness campaigns focusing on older adults that explain the importance of seeking treatment is needed, as well as sensitising health professionals as to the importance of informing and aiding individuals at risk of social isolation and lower socio-economic status as to available mental health resources and facilitating access to care.