Previously submitted to: JMIR Public Health and Surveillance (no longer under consideration since Jun 24, 2025)
Date Submitted: Jun 23, 2025
Open Peer Review Period: Jun 24, 2025 - Jun 24, 2025
(closed for review but you can still tweet)
NOTE: This is an unreviewed Preprint
Warning: This is a unreviewed preprint (What is a preprint?). Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn (a note "no longer under consideration" will appear above).
Peer review me: Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period (in this case, a "Peer Review Me" button to sign up as reviewer is displayed above). All preprints currently open for review are listed here. Outside of the formal open peer-review period we encourage you to tweet about the preprint.
Citation: Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author).
Final version: If our system detects a final peer-reviewed "version of record" (VoR) published in any journal, a link to that VoR will appear below. Readers are then encourage to cite the VoR instead of this preprint.
Settings: If you are the author, you can login and change the preprint display settings, but the preprint URL/DOI is supposed to be stable and citable, so it should not be removed once posted.
Submit: To post your own preprint, simply submit to any JMIR journal, and choose the appropriate settings to expose your submitted version as preprint.
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Evaluating the Impact of Bulk Billing Policy Changes on Mental Health Service Utilisation in Australia (2019–2023): A Time Series Analysis
ABSTRACT
Background:
Between 2019 and 2023, Australia introduced several bulk billing policy reforms, including increased financial incentives and expanded telehealth access, to improve mental health service utilisation. However, overlapping reforms and rising operational costs have made their overall impact unclear.
Objective:
The study was conducted to evaluate the impact of bulk billing changes (from 2019 to 2023) on mental health service use and access disparities across states and territory in Australia.
Methods:
We conducted an Interrupted Time Series (ITS) analysis using Generalised Linear Mixed Models (GLMMs) and Hurdle Models to assess changes in utilisation of three mental health services—fully covered in-person (MBS 2715), partially covered in-person (MBS 281), and fully covered telehealth (MBS 92116)—from October 2018 to December 2022. Major policy interventions in April 2020 and July 2021 were evaluated.
Results:
Following the April 2020 incentive increase, in-person services (MBS 2715) showed a significant upward trend (β = 0.05, p = 0.031). In contrast, the July 2021 reduction in telehealth incentives was associated with a 7.7% decline in the odds of telehealth service use (MBS 92116), based on modelled estimates (Logistic: β = -0.08, p = 0.010). Utilisation remained lower among men and older adults.
Conclusions:
Bulk billing reforms significantly affect mental health service utilisation, with affordability and incentive stability shaping access patterns. Policy shifts that reduce incentives can rapidly decrease usage, particularly in telehealth. Sustainable reform should combine consistent funding with targeted strategies to address demographic and geographic disparities.
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.