Provision of Australian medicare-reimbursed video telepsychiatry services: a postcode-level data-linkage analysis

Using the largest database of psychiatric consultations in Australia, comprising 13.5 million Medicare Benefits Schedule consultation records (2017–2023) linked with the 2021 Census data, this study describes telepsychiatry utilisation trends and factors associated with video mode choice across telehealth policy periods. We computed the provider’s postcode-level monthly and yearly fractions of face-to-face, video, and telephone consultations. We analysed the geographic concentrations of each mode using the Herfindahl-Hirschman Index (HHI). We conducted a fractional logit regression analysis for the associated factors of the video consultation fraction. Video consultations increased sharply from 5% of all psychiatric contacts in 2017 to 23% in 2020 and 28% in 2023, while the geographic concentration of service provision, measured by the HHI, more than halved (from 0.026 to 0.011), indicating a marked geographic dispersion of service provision. Fractional logit models demonstrated that video use was more common among metropolitan clinicians and practices with higher proportions of female patients, but less common when patients were older or lived in more socioeconomically advantaged areas. During the consolidation phase of policy implementation, remote and regional providers increased services to metropolitan patients by 450–783%, signalling cross-regional integration of service delivery. Telehealth-enabling policies are associated with a sustained and more geographically diverse psychiatric care provision, with participation expanding among both urban and rural providers. Nevertheless, persistent sociodemographic gradients highlight the need for targeted policy and service planning for equitable access to telepsychiatry as it becomes an established mode of care.