Negative consequences of 2500 “Free” ADHD assessments

The NSW Government has implemented a series of prescribing reforms to address the affordability and accessibility of assessments for ADHD, including the training and authorisation of GPs to prescribe stimulant medications (dexamfetamine and methylphenidate). From the limited detail provided so far, in 2027, NSW residents will compete for 2500 subsidised ADHD assessments provided via bulk-billed GP authorised prescribers. While there are no out-of-pocket costs, there are presumably initial costs borne by NSW taxpayers, with an overall package cost of $11.7 million (2.7 million for prescriber training, 5.7 million to fund specialist paediatric/psychiatric support, $1.5 million for incentives, and for the remainder, by our calculations, a potential subsidy for access to allied health assessments and support of $1.8 million. 

Unintended side effects of increased ADHD assessments

We previously found that Medicare-subsidised psychiatrist telehealth provision of assessments for ADHD, whilst providing increased access to those in rural and remote areas, led to increased prescribing and out-of-pocket costs for all patients. This indicates that government interventions, such as the permanent subsidy for telepsychiatry, can have unintended market and consumer consequences. These include the reduction of access to psychiatric care for other conditions due to the focus on ADHD, which is known as a crowding-out effect.

There is a relatively limited supply of psychiatrists and if ADHD assessments are incentivised or enabled this can create market incentivises for the scarce workforce to move from the public sector into more lucrative private sector ADHD based assessments.

The outlined program also presents potentially unintended risks: the associated government funding intervention may similarly impact the market for ADHD assessments. On referral from a patient’s own GP, the NSW Government will subsidise practices $600 for authorised GPs to perform bulk-billed ADHD assessments, limited to a total of 2500 assessments (a cost we estimate as $1.5 million). For those successfully able to compete for one of the 2500 assessments, there is intended to be no out-of-pocket cost.

The market impact of the GP ADHD assessment subsidy may be substantial. There may be a decrease in access to GP appointments for other health conditions in subsidised practices – the crowding-out effect. Also, as the subsidy is limited to 2500 assessments, it will certainly stimulate further interest in assessments that cannot be met by the program. The resultant queues for a scarce resource will result in further pressure on NSW government to further expand the program.

A health workforce stretched thin

The NSW Government reported in June 2026 that there were 330 GP prescribers being trained to be authorised prescribers in a six-month program, with another waitlisted intake intended in November 2026. With the most favourable assumptions, if all 330 prescribers complete training, that workforce will be able to provide 2500/330 — 7.6 subsidised assessments each. While authorised GPs may perform more bulk-billed assessments beyond the subsidised number, it is not clear why they or their practices would do so.

As we previously found, social media interest, quantified through Google search, and the introduction of the telepsychiatry subsidy increased demand, access and out-of-pocket costs. Providers shifted to a market model that incorporated the Medicare subsidy for patients, and which was priced for the demand for access. 

The proposed NSW Government subsidies may similarly increase demand for ADHD assessments. However, the very limited numbers of authorised GP prescribers and authorised specialists (which are not increased by this initiative) will still limit access. This creates a parallel competitive market for non-subsidised appointments with authorised GPs, and also specialist paediatricians, psychiatrists and neurologists. Such increased demand, in the context of limited accessibility, as seen previously in our study on telepsychiatry and ADHD prescribing, drives up out-of-pocket costs. 

The limited-capacity oasis of NSW Government-subsidised GP ADHD assessments will likely only worsen accessibility, and increase out-of-pocket costs, by sparking demand and consumer expectations that cannot be met. 

Systematic research into the multifarious factors that underlie the interest in ADHD assessment and effective interventions is needed to drive evidence-based policy that improves the care of people with ADHD. As a crisis intervention with lack of consideration of its long-term market effects, the GP authorised provider subsidy will likely worsen the future environment for care.

Luke Sy-Cherng Woon, Visiting Fellow, National Centre for Health Workforce Studies, Australian National University; Lecturer, Faculty of Medicine, The National University of Malaysia

Wai-Man Liu, Associate Professor, Research School of Finance, Actuarial Studies and Statistics, Australian National University; National Centre for Health Workforce Studies, Australian National University

Tarun Bastiampillai, Professor of Psychiatry, Flinders University; Adjunct Clinical Professor of Psychiatry, Monash University

Jeffrey C.L. Looi, Associate Professor, Social Psychiatry and Epidemiology Research Unit, School of Medicine and Psychology, Australian National University

Disclosure statement

Jeffrey C.L. Looi is a private practice academic neuropsychiatrist who provides face-to-face consultations and telepsychiatry. He has been a private psychiatrist representative of the RANZCP, and is a former federal council psychiatrist representative, and Fellow of the Australian Medical Association. Views expressed in this article are his own, and not those of any organisation he is affiliated with.

Tarun Bastiampillai is on the board of Australian Medical Association SA and the Australian Society of Psychiatrists. His views expressed in this article are his own, and not those of any organisation he is affiliated with.

Luke Sy-Cherng Woon and Wai-Man Liu do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.