| Medicare Review Challenges Two-Tiered System |
 |
 |
 |
| Written by Ben Mullings |
| Monday, 18 April 2011 08:18 |
|
OverviewTo explain this a little more for people outside of the field of psychology, the Medicare system in it's present form divides psychology into two camps: 'clinical psychologists' and 'registered psychologists'. It is claimed by those who devised the scheme that psychologists who are eligible for entry to the APS College of Clinical Psychology are the only ones who have what it takes to work with serious mental health issues. That might sound good on face value, but what this actually means in practical terms is that specialists from other areas who routinely assess, diagnose and treat serious mental health disorders are told that they cannot provide 'psychological therapy'. This includes Counselling Psychologists, who actually specialise in psychological therapy (page 7); as well as Clinical Neuropsychologists who specialise in serious neurological conditions; and Developmental Psychologists who specialise in work with developmental disorders. The lower-tier of Medicare also includes many of our most experienced senior members of the profession, who have been providing assessment, diagnosis and treatment to people in our community for decades. The question is, does the Medicare Review support the way that the profession of psychology has been split into two tiers. In a word the answer is "no". The Medicare Review found no difference in the clinical outcomes for those who saw a 'clinical psychologist' versus those who saw a 'registered psychologist'. Both kinds of psychologist saw people with the same severity of symptoms and over the same period of treatment they both performed equally well in measurable terms. And according to this new research clients were just as satisfied with seeing registered psychologists too. These findings align with earlier surveys of psychologists in the Medicare system who identified that clinical and registered psychologists saw clients with the same types of conditions with similar levels of symptom severity and that an equivalent proportion of people improved as a result of psychological treatment. What does all of this mean?This large-scale review of the Better Access initiative will shock advocates of the two-tiered system, particularly factions who have made the false claim that only clinical psychologists receive the right kind of training to work with serious mental health issues. Even the former President of the APS claimed that: "It is reasonable to expect that general and clinical psychologists will often be treating cases of different complexity. It is this and their more extensive, specialised training that justifies the higher Medicare rebates for their patients." When he made this statement through an official official press release from the APS, he implied that clinical psychologists were also more capable of treating complex and co-morbid cases. He made mention of the fact that there was no evidence at the time that registered psychologists were capable of delivering equivalent outcomes with these cases. This was a truly bizarre claim to make, given that less than a year before that press release had been issued, the APS undertook their own research about psychological services provided through the Medicare system (June 2008). Even their own research provided evidence that there were no differences between the two-tiers of practitioners in the Better Access system. And now further evidence has come in from Medicare, demonstrating once again that there are no differences in the clinical outcomes achieved by both groups. This large scale outcome study challenges the entire basis for differentiating clinical psychologists from others, suggesting that the two-tiered feature of the current Medicare system might be scrapped altogether. If you are familiar with psychotherapy research, you wont find these results surprising at all. There are now a plethora of studies that point to the fact that the lion's share of improvement from psychological treatment comes from common factors, rather than the particular brand of training that a psychotherapist prescribes to. No sensible person who is familiar with the research would honestly expect that being a Clinical Psychologist would make the practitioner any better than a Counselling Psychologist, or any other mental health specialist. When it comes to developing expertise with complex cases, we know that other factors are far more important to consider here, such as years of training, supervision, experience in the field and other characteristics of the therapist. More to the point, the present structure of the two-tiered system is a mixed bag. Each tier of the system is comprised of a variety of different practitioners. If the two tiers of Medicare are comprised of practitioners that possess a similar level of training and a similar amount of experience in the field, then why would we expect there to be any significant difference between these groups? Indeed, it has been argued that there are more differences between practitioners within each category, than there are differences between groups when it comes to the two-tiers of Medicare. In simple terms, the two-tiers of Medicare are not as neatly divided as some clinical psychologists have claimed. It is worth pointing out that it is somewhat easier to claim superiority when your own group is favoured by the system. SolutionsThere have been growing calls for all psychologists to be treated equally in the Medicare system - and the results from this Medicare review support that conclusion. For a long time, those practitioners who are classified as 'generalists' in the Better Access initiative have felt as though they are treated like second-class psychologists. At the end of the day though, it has been the most vulnerable and distressed members of the Australian public who have had to bear the cost of a system that discriminates against so many of our psychologists with advanced training in mental health care. The fairest way to resolve this problem is to simplify the Better Access initiative to a single-tiered system allowing all psychologists to offer the same Medicare rebate. This proposal will go a long way to quell tensions within the profession and is the only solution that matches with the research evidence. But while we know that the government has been waiting for this evidence to come in to inform the next round of reforms in mental health policy, the question remains whether they will allow political bias to continue to favour clinical psychologists, despite the evidence. Whether you are a psychologist, a client, or any other person interested in this issue - please share your thoughts by leaving a comment below. NOTE: All responses to this material will be posted in the section below. Comments (22)
 |
| Last Updated on Tuesday, 15 November 2011 22:38 |
Earlier this month the Federal Mental Health Minister Mark Butler released the long awaited 
Show/hide comments
