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.

Efficacy, patient-doctor relationship, costs and benefits of utilizing telepsychiatry for the management of post-traumatic stress disorder (PTSD): a systematic review

Abstract Introduction Post-traumatic stress disorder (PTSD) is one of the most common psychiatric disorders found among victims of disaster, kidnapping, accidents, sexual assaults and war in Indonesia. However, lacking and unequal distribution of psychiatric medical personnel remains a barrier to its management. This review aims to introduce and evaluate the potential contribution of telepsychiatry to the management of PTSD based on published literature. Methods Original studies were obtained from PubMed, Science Direct, ProQuest, High Wire, and Elsevier Clinical Key databases. Results A total of 125 articles were found, of which 15 articles (12 randomized controlled trials, 2 open trials and 1 pilot study) fulfilled the inclusion criteria. A total of 991 subjects were found with a follow-up period ranging between 5 weeks and 18 months. Telepsychiatry is an innovative use of technology to aid the delivery of PTSD treatments in areas difficult to reach. The quality of care given by telepsychiatry both through video conferencing as well as web- and application-based is comparable to that of face-to-face therapy. Patient satisfaction, quality of doctor-patient relationship also remains high, with lower costs and shorter therapeutic time when compared to face-to-face therapy. Conclusion Various studies have shown that telepsychiatry is an effective solution for the management of PTSD. Studies have also reported that the quality of treatment through telepsychiatry is as effective as face-to-face therapy, with greater efficiency. Countries, especially those with a low patient-to-mental health professional ratio, should be encouraged to develop telepsychiatry systems to manage PTSD.

Médicos e loucos no sul do Brasil: um olhar sobre o Hospício São Pedro de Porto Alegre/RS, seus internos e as práticas de tratamento da loucura (1884-1924) / Doctors and madmen in south of Brazil: an overview on the Sao Pedro Hospice in the city of Porto Alegre/RS, its patients and its practices of madness treatment (1884-1924)

O Hospício São Pedro foi inaugurado em 29 de junho de 1884, sendo o primeiro hospital psiquiátrico do estado do Rio Grande do Sul e um dos primeiros do Brasil, cuja história a partir deste marco, tornou-se correlata da construção da psiquiatria na então província. Este artigo apresenta uma breve história da instituição até a década de 1920, analisando dados sobre a população de internos. Além disto, reflete-se sobre as práticas médicas de assistência no interior do hospício, nas quais foram conjugados na construção da «cura» dos sujeitos, os preceitos da ciência e os atributos físicos e culturais, bem como as experiências de vida dos internos (AU)

The São Pedro Hospice was inaugurated on June 29, 1884, and it was the first psychiatric hospital of Rio Grande do Sul State and one of the first of Brazil, whose history was in a turning point, and it became correlated with the construction of the psychiatry then province. This article presents an abbreviation history of the institution until the decade of 1920, it analyzes the data of the internal population. Moreover, it deals with the medical practices of attendance inside the hospice, which were combined with the development of the “cure” of the subjects, the precepts of the science and the physical and cultural attributes, as well as the experiences of the inpatients’ life (AU)

Antecedentes da reforma psiquiátrica no Brasil: as contradições dos anos 1970 / The prelude to psychiatric reform in Brazil: the contradictions of the 1970

O objetivo deste trabalho é a reconstituição histórica do período imediatamente anterior àquele que se denominou Movimento de Reforma Psiquiátrica no Brasil. Os marcos desse período são a criação do INPS, em 1967, e o momento em que ganhou destaque o Movimento dos Trabalhadores em Saúde Mental, em 1978. Discutem-se as contradições da política oficial de saúde mental no país, enfocando critérios técnicos influenciados pelo modelo preventivista norte-americano, e a prática de financiamento e fortalecimento das instituições psiquiátricas privadas, em detrimento das ações comunitárias. Embora a maioria dos documentos oficiais da década de 1970 apresente uma proposta claramente voltada para as ações comunitárias, o que se observou foi a cristalização do modelo de compra de leitos psiquiátricos em hospitais privados pelo poder público.

Análisis de costes y servicios psiquiátricos para pacientes esquizofrénicos. El modelo EPCAT / Cost and psychiatric services analysis for schizophrenic patients. The EPCAT model

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Los aspectos económicos en psiquiatría: hacia una práctica clínica basada en la racionalidad / The economical aspects in psychiatry: towards a clinical practice based in racionality

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El tratado de libre comercio y la psiquiatría: retos, riesgos y oportunidades / NAFTA and psychiatry: challenges, risks and opportunities

Se anticipa del Tratado de Libre Comercio de Norte américa tendrá importantes consecuencias comerciales, sociales y culturales para los países signatarios, de las que no está exento el campo de la salud. El propósito de este trabajo ha sido examinar, desde el punto de vista mexicano, algunos de los efectos que se pueden anticipar en el campo particular de la psiquiatría y la salud mental. Un punto de partida sería comparar las condiciones y los recursos con que cuentan los países participantes. Por ello, se examinan las asimetrías entre los países en términos de indicadores de salud, sistemas de salud, recursos y prácticas profesionales. Un área abierta a la negociación es la posible homologación de programas de adiestramiento, y la certificación de especialistas, con el propósito de llegar a un mutuo reconocimiento. Se concluye que el tratado ofrece bases nuevas para aumentar la colaboración en el área de la psiquiatría y de la salud mental entre los países participantes