Table 1 Comparison of mental health service systems in Australia, New Zealand, Canada and the United States

Health service system and private insurance role

Universal public medical insurance programme (Medicare); regionally administered public hospital funding ~47.3% buy complementary and supplementary coverage

Universal public medical insurance programme that plans and funds (mainly private) provision, administered separately by each province/territory ~67% buy complementary coverage for non-covered benefits

National healthcare system; District Health Boards are responsible for planning, funding and provision ~33% buy complementary coverage and supplementary coverage

Medicare provides insurance for those aged 65 and older, some disabled; Medicaid provides insurance for low-income; for those without employer coverage, state-level insurance exchanges exist with income-based subsidies ~66% of population is covered by primary private voluntary insurance (employer-based and individual)

Funding for mental health

Mental health-related general practitioner (GP), psychologist and specialist consultations are reimbursed by Medicare; inpatient admissions to public hospitals are free

Mainstream GP, specialist and hospital mental health services are provided free by provinces and territories; National government supports mental health services for a subset of populations

District Health Boards fund community and institutional care for mental health needs; inpatient and outpatient public hospital services are free

Most private health insurance plans are required to cover mental health and substance use disorder services; all Medicaid and Medicare cover some mental health services

Health service system applicable to Indigenous population

Largely administered by mainstream organisations; some care is provided by the National Aboriginal Community Controlled Organisation, a network of independent local health services owned and run by local Aboriginal and Torres Strait Islander communities

Through the First Nations and Inuit Health Branch, the federal government delivers certain mental health services and funds non-insured health benefits (including counselling) to eligible First Nations and Inuit communities

Primary Health Organisations, funded by District Health Boards, are customised to their enrolled populations, sometimes with a focus on the Maori population

The federal government fully funds health services, including mental health services, for Native Americans and Alaska Natives through a combination of Medicaid and care delivered by the Indian Health Service