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Regional variation in mental healthcare utilization and suicide: Evidence from movers in Australia

Author

Listed:
  • Karinna Saxby

    (The Melbourne Institute: Applied Economic and Social Research, The University of Melbourne)

  • Thomas Buchmueller

    (Ross School of Business, University of Michigan)

  • Sonja C. de New

    (Centre for Health Economics, Monash Business School, Monash University, IZA,RWI)

  • Dennis Petrie

    (Centre for Health Economics, Monash Business School, Monash University)

Abstract

Poor mental health is a major global health issue, with many countries documenting high levels of unmet need and regional disparities in mental healthcare utilization. To determine how best to address these disparities, it is important to understand what drives regional variation. Using Census-linked microdata from Australia, we exploit cross-region migration to identify the extent to which patient and place factors drive regional variation in utilization of mental healthcare services and mental health prescriptions (antidepressants, anxiolytics, antipsychotics). We find that place factors account for approximately 72% and 19% of the regional variation in utilization of mental healthcare services and mental health prescriptions, respectively, with the rest reflecting patient-related demand. We also find suggestive evidence that larger place effects predict fewer mental health related ED presentations, self-harm hospitalizations, and suicides. Altogether, our findings suggest there is inadequate and inequitable supply in regions with low utilization, rather than inefficiently high utilization in high utilization regions.

Suggested Citation

  • Karinna Saxby & Thomas Buchmueller & Sonja C. de New & Dennis Petrie, 2025. "Regional variation in mental healthcare utilization and suicide: Evidence from movers in Australia," Papers 2025-11, Centre for Health Economics, Monash University.
    • Handle: RePEc:mhe:chemon:2025-11
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    References listed on IDEAS

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    1. Ludwig, Jens & Marcotte, Dave E. & Norberg, Karen, 2009. "Anti-depressants and suicide," Journal of Health Economics, Elsevier, vol. 28(3), pages 659-676, May.
    2. Christian Dustmann & Francesco Fasani, 2016. "The Effect of Local Area Crime on Mental Health," Economic Journal, Royal Economic Society, vol. 126(593), pages 978-1017, June.
    3. Sefa Awaworyi Churchill & Lisa Farrell & Russell Smyth, 2019. "Neighbourhood ethnic diversity and mental health in Australia," Health Economics, John Wiley & Sons, Ltd., vol. 28(9), pages 1075-1087, September.
    4. Clément de Chaisemartin & Xavier D'Haultfœuille, 2020. "Two-Way Fixed Effects Estimators with Heterogeneous Treatment Effects," American Economic Review, American Economic Association, vol. 110(9), pages 2964-2996, September.
    5. Jeffrey R Kling & Jeffrey B Liebman & Lawrence F Katz, 2007. "Experimental Analysis of Neighborhood Effects," Econometrica, Econometric Society, vol. 75(1), pages 83-119, January.
    6. Curry, Aaron & Latkin, Carl & Davey-Rothwell, Melissa, 2008. "Pathways to depression: The impact of neighborhood violent crime on inner-city residents in Baltimore, Maryland, USA," Social Science & Medicine, Elsevier, vol. 67(1), pages 23-30, July.
    7. Pulok, Mohammad Habibullah & van Gool, Kees & Hall, Jane, 2020. "Inequity in physician visits: the case of the unregulated fee market in Australia," Social Science & Medicine, Elsevier, vol. 255(C).
    8. Matthew Lang, 2013. "The Impact Of Mental Health Insurance Laws On State Suicide Rates," Health Economics, John Wiley & Sons, Ltd., vol. 22(1), pages 73-88, January.
    9. Cook, Benjamin Lê & Doksum, Teresa & Chen, Chih-nan & Carle, Adam & Alegría, Margarita, 2013. "The role of provider supply and organization in reducing racial/ethnic disparities in mental health care in the U.S," Social Science & Medicine, Elsevier, vol. 84(C), pages 102-109.
    10. Salm, Martin & Wübker, Ansgar, 2020. "Sources of regional variation in healthcare utilization in Germany," Journal of Health Economics, Elsevier, vol. 69(C).
    11. Saxby, Karinna & de New, Sonja C. & Petrie, Dennis, 2020. "Structural stigma and sexual orientation disparities in healthcare use: Evidence from Australian Census-linked-administrative data," Social Science & Medicine, Elsevier, vol. 255(C).
    12. Mullins, Jamie T. & White, Corey, 2019. "Temperature and mental health: Evidence from the spectrum of mental health outcomes," Journal of Health Economics, Elsevier, vol. 68(C).
    13. John Mullahy & Edward C. Norton, 2024. "Why Transform Y? The Pitfalls of Transformed Regressions with a Mass at Zero," Oxford Bulletin of Economics and Statistics, Department of Economics, University of Oxford, vol. 86(2), pages 417-447, April.
    14. Callaway, Brantly & Sant’Anna, Pedro H.C., 2021. "Difference-in-Differences with multiple time periods," Journal of Econometrics, Elsevier, vol. 225(2), pages 200-230.
    15. Isabel Correia & Paula Veiga, 2010. "Geographic distribution of physicians in Portugal," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(4), pages 383-393, August.
    16. Godøy, Anna & Huitfeldt, Ingrid, 2020. "Regional variation in health care utilization and mortality," Journal of Health Economics, Elsevier, vol. 71(C).
    17. Naimi Johansson & Mikael Svensson, 2022. "Regional variation in prescription drug spending: Evidence from regional migrants in Sweden," Health Economics, John Wiley & Sons, Ltd., vol. 31(9), pages 1862-1877, September.
    18. Johansson, Naimi & Jakobsson, Niklas & Svensson, Mikael, 2024. "Place or patient as the driver of regional variation in healthcare spending – Discrepancies by category of care," Social Science & Medicine, Elsevier, vol. 342(C).
    19. Bharadwaj, Prashant & Pai, Mallesh M. & Suziedelyte, Agne, 2017. "Mental health stigma," Economics Letters, Elsevier, vol. 159(C), pages 57-60.
    20. Black, Nicole & Johnston, David W. & Ride, Jemimah, 2025. "Children's access to mental healthcare: Parental perceptions and resource constraints," Social Science & Medicine, Elsevier, vol. 370(C).
    21. Moscone, Francesco & Knapp, Martin & Tosetti, Elisa, 2007. "Mental health expenditure in England: A spatial panel approach," Journal of Health Economics, Elsevier, vol. 26(4), pages 842-864, July.
    22. Ana Moura & Martin Salm & Rudy Douven & Minke Remmerswaal, 2019. "Causes of regional variation in Dutch healthcare expenditures: Evidence from movers," Health Economics, John Wiley & Sons, Ltd., vol. 28(9), pages 1088-1098, September.
    23. Sun, Liyang & Abraham, Sarah, 2021. "Estimating dynamic treatment effects in event studies with heterogeneous treatment effects," Journal of Econometrics, Elsevier, vol. 225(2), pages 175-199.
    24. Swami, Megha & Scott, Anthony, 2021. "Impact of rural workforce incentives on access to GP services in underserved areas: Evidence from a natural experiment," Social Science & Medicine, Elsevier, vol. 281(C).
    25. Nicole Black & David W. Johnston & Martin Knapp & Michael A. Shields & Gloria H. Y. Wong, 2025. "Horizontal inequity in the use of mental healthcare in Australia," Health Economics, John Wiley & Sons, Ltd., vol. 34(2), pages 297-315, February.
    26. Meliyanni Johar & Chunzhou Mu & Kees Van Gool & Chun Yee Wong, 2017. "Bleeding Hearts, Profiteers, or Both: Specialist Physician Fees in an Unregulated Market," Health Economics, John Wiley & Sons, Ltd., vol. 26(4), pages 528-535, April.
    27. Ayyagari, Padmaja & Shane, Dan M., 2015. "Does prescription drug coverage improve mental health? Evidence from Medicare Part D," Journal of Health Economics, Elsevier, vol. 41(C), pages 46-58.
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    Keywords

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    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • J18 - Labor and Demographic Economics - - Demographic Economics - - - Public Policy

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