Better health and ageing for all Australians

Aboriginal and Torres Strait Islander Health Performance Framework - 2010

3.12 Access to services by types of service compared to need

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Why is it important?:

Measures presented in this section examine the level of access to health care for Aboriginal and Torres Strait Islander peoples compared with their need for health care. Indigenous Australians have significantly poorer health status than non-Indigenous Australians, life expectancy is 11.5 years less for males and 9.7 years less for females and Indigenous Australians are twice as likely to rate their health as fair or poor compared with non-Indigenous Australians. Access to health care when needed is essential to closing the gap in Indigenous life expectancy.

Findings:

In 2004–05, 42% of Indigenous Australians reported accessing health care in the last two weeks or hospital in the last 12 months. After adjusting for age differences between the two populations, Indigenous Australians accessed health care at similar rates to non-Indigenous Australians. In the previous two weeks, 20% of Aboriginal and Torres Strait Islander people had visited a doctor or specialist, 5% casualty/outpatients, 17% other health professionals, and 4% dentists. In the previous 12 months, 16% had been admitted to hospital.

Indigenous Australians were more than twice as likely to visit casualty/outpatients and half as likely to see a dentist. For people reporting fair or poor health, 40% of Indigenous Australians and 42% of non-Indigenous Australians reported visiting a doctor in the last 2 weeks, 11% of Indigenous and 6% of non-Indigenous Australians reported visiting a casualty department or outpatient clinic and 30% of Indigenous and 27% of non-Indigenous Australians reported admission to hospital in the last 12 months. After adjusting for differences in age structure, 36% of Indigenous people reported that it had been two years or more since their last dental consultation, compared with 29% of non-Indigenous people. Reported use of these health services has not changed significantly since the last survey in 2001. Indigenous Australians were hospitalised for palliative care 1.4 times the rate of other Australians. The overall rate of elective surgery for Indigenous Australians (49 per 1,000 persons) was markedly lower than for other Australians (86 per 1,000 persons) (AIHW 2008d).

In 2008, 30% of Aboriginal and Torres Strait Islander peoples aged 15 years and over reported problems with accessing health and other services (e.g. legal, employment and Centrelink). Access issues were higher in remote areas than non-remote areas. Of the people reporting having problems accessing services, close to two-thirds reported having problems accessing dentists, followed by doctors (32%), hospitals (22%) and Aboriginal and Torres Strait Islander health workers (19%).

In 2004–05, 15% of Aboriginal and Torres Strait Islander people reported that at some time in the last 12 months they did not go to a doctor when needed, 7% did not go to hospital when needed, 21% did not go to a dentist when needed and 8% did not go to another health professional when needed. A higher percentage of Indigenous Australians in non-remote areas reported not accessing doctors, dentists and other health professionals when needed compared with those living in remote areas. Reasons for not accessing services vary between regions. In non-remote areas, cost is a more important factor. In remote areas, transport/distance and the lack of availability of services are more important. Waiting times were also important factors for not accessing doctors, hospitals, dentists and other health professionals. In addition, barriers such as disliking the service/professional, feeling afraid or embarrassed were also mentioned. Many of these issues relate to the cultural appropriateness of the service. Cost was the main reason Aboriginal and Torres Strait Islander people did not visit a dentist (29%).

In 2004–05, around 15% of Indigenous Australians in non-remote areas required co-payment for their last visit to the doctor, 37% required co-payment for their last visit to a specialist and 17% required co-payment for their last visit to other health professionals. In non-remote areas, 15% of Indigenous Australians are covered by private health insurance compared with an estimated 51% for the rest of the population. The most common reason that Indigenous Australians did not have private health insurance was that they could not afford it (65%).

In 2009–10, Indigenous Australians had 5.4 million Medicare claims of which 2.7 million were for non-referred GP consultations (note: not all episodes of care delivered through Indigenous primary health care services can be claimed through Medicare). The two most common Medicare items claimed by Indigenous Australians were standard GP consultations followed by pathology. In 2009–10, out-of-pocket costs for services claimed through Medicare were lower for Indigenous Australians (9% of fees claimed) than non-Indigenous Australians (21% of fees claimed). After adjusting for differences in age structure of the populations, Indigenous Australians received fewer Medicare services per 1,000 in the population overall for every type of service except non-referred GP items and pathology. Within the non-referred GP category, Indigenous Australians were more likely than non-Indigenous Australians to have received services for longer GP consultations, nurse/Aboriginal Health Worker consultations, Indigenous health checks, GP management plans and team care arrangements. Service claims for imaging, private specialists and allied health care were all lower for Indigenous Australians. There was a clear gradient in service claims reducing by remoteness with rates per 1,000 falling for all types of services (except out of hospital pathology claims). The disparity between Indigenous and non-Indigenous Australians for private specialist care claimed through Medicare increased with remoteness. Indigenous Australians living in major cities claimed for private specialist services at a rate of 861 per 1,000 compared to 1045 per 1,000 for non-Indigenous Australians. In very remote areas Indigenous Australians claimed for private specialist services at a rate of 185 per 1,000 compared to 426 per 1,000 for non-Indigenous Australians. Indigenous women had higher rates of services claimed per 1,000 through Medicare than Indigenous men. Indigenous Australians had higher rates of services claimed in the 15–54 year age group compared with non-Indigenous Australians and lower rates in the 0–14 years and 55 years plus age groups.

Over the last five years, there has been a steady rise in the number of Aboriginal and Torres Strait Islander primary health care services; from 120 services in 1999–2000 to 156 services in 2007–08. Between 1999–2000 and 2007–08, episodes of health care provided to clients of these services have increased by 52% from 1.22 million to 1.85 million. Equivalent full-time staff (both paid by the service and visiting) increased by 89% over the same period.

Implications:

Aboriginal and Torres Strait Islander peoples report similar rates of access to health care overall with differences evident by type of care. These differences are associated with factors such as cost, cultural appropriateness and access. Data in this report suggest that Aboriginal and Torres Strait Islander peoples have significantly poorer health and therefore we should expect to see access to health services 2–3 times higher rather than 1.1 times higher. Gaps in access to dental services are clear from the national survey data. Less is known about disparities in access to specialist services however these also require attention. Indigenous Australians have much lower levels of private health insurance, rely on public hospital services to a greater degree and have lower rates of elective surgery. Barriers to accessing care when needed vary between remote and non-remote areas, suggesting that strategies need to be adapted for local circumstances.

The National Indigenous Reform Agreement notes that ‘All health services play an important role in providing Indigenous people with access to effective health care, and being responsive to and accountable for achieving government and community health priorities.’ (COAG 2008b, p.6) In support of this work, COAG has agreed to the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes which aims to improve the way the Australian health care system prevents, treats and manages chronic diseases.

As part of National Health Reform, the implementation of Medicare Locals will aim to improve and strengthen the coordination and integration of primary health care in local communities, address service gaps and make it easier for patients to navigate their local health care system. The five strategic objectives of Medicare Locals are to: improve the patient journey through developing integrated and coordinated services; provide support to clinicians and service providers to improve patient care; identify the health needs of local areas and develop locally focused and responsive services; facilitate the implementation and successful performance of primary health care initiatives and programs; and be efficient and accountable with strong governance and effective management.

Ongoing community engagement and input is a requirement of GP Super Clinics organisational governance arrangements in order to respond to local community needs and priorities, including those of Indigenous Australians.

Figure 165 – Age-standardised MBS claim rate, by Indigenous status, Australia, 2009–10


Figure 165 – Age-standardised MBS claim rate, by Indigenous status, Australia, 2009–10
Source: Medicare Financing & Analysis Branch, Department of Health and Ageing
Text description of figure 165 (TXT 1KB)

Figure 166 – Age-standardised MBS claim rate for specialist services, by remoteness, Australia, 2009–10


Figure 166 – Age-standardised MBS claim rate for specialist services, by remoteness, Australia, 2009–10
Source: Medicare Financing & Analysis Branch, Department of Health and Ageing
Text description of figure 166 (TXT 1KB)

Figure 167 – Proportion of people who accessed health care, by type of health care, within the last 12 months (hospital) or last 2 weeks (other health care), by Indigenous status, and number of self-reported number long-term health conditions, Australia 2004–05


Figure 167 – Proportion of people who accessed health care, by type of health care, within the last 12 months (hospital) or last 2 weeks (other health care), by Indigenous status, and number of self-reported number long-term health conditions, Australia 2
Source: ABS and AIHW analysis of 2004–05 National Aboriginal and Torres Strait Islander Health Survey and 2004–05 National Health Survey
Text description of figure 167 (TXT 1KB)

Table 67 – Whether needed to go to a dentist, doctor, other health professional or hospital, reasons didn’t go, by remoteness area, Aboriginal and Torres Strait Islander peoples, 2004–05

Dentist
Doctor
Health Professional
Hospital
Non-remote
Remote
Total
Non-remote
Remote
Total
Non-remote
Remote
Total
Non-remote
Remote
Total
%
%
%
%
%
%
%
%
%
%
%
%
Needed to go to service in the last 12 months but didn't
23
16
21
17
10
15
9
5
8
7
7
7
Reasons why didn't visit:
Cost
32
15
29
14
4*
12
33
5#
28
5*
3*
4
Too busy
15
11
14
26
17
24
27
20
26
17
16
16
Dislikes
21
20
21
10
11
10
12
11*
12
18
9*
16
Waiting time too long or not available at time required
21
23
22
14
15
14
7*
19
9
18
10*
16
Decided not to seek care
14
8
13
27
22
26
18
16
17
25
26
25
Transport/distance
7
28
11
11
28*
14
7*
15*
8
13
34
19
Not available in area
3
28
8
2#
13*
4*
2*
30
7
2*
8*
4*
Felt it would be inadequate
2*
2#
2*
5
7*
5
5*
5#
5
6
7*
6
Discrimination/ not culturally appropriate/ language problems
—#
1#
— *
1
1#
1*
2#
2#
2*
2*
2#
2*
Other
9
7*
8
12
5
11
11
10*
11
15
9
14
* Estimate has a relative standard error between 25% and 50% and should be used with caution.
# Estimate has a relative standard error greater than 50% and is considered too unreliable for general use.
ABS & AIHW analysis of 2004–05 National Aboriginal and Torres Strait Islander Health Survey

Figure 168 – Cumulative per cent changes to Aboriginal and Torres Strait Islander primary health care services, 1999–2000 to 2007–08


Figure 168 – Cumulative per cent changes to Aboriginal and Torres Strait Islander primary health care services, 1999–2000 to 2007–08
Source: Service Activity Reporting 2005–06
Text description of figure 169 (TXT 1KB)

Figure 169 – Age-standardised hospitalisation rates by Indigenous status and remoteness, NSW, Vic, Qld, WA, SA and NT, July 2007 to June 2009


Figure 169 – Age-standardised hospitalisation rates by Indigenous status and remoteness, NSW, Vic, Qld, WA, SA and NT, July 2007 to June 2009
Source: AIHW analysis of National Hospital Morbidity Database
Text description of figure 169 (TXT 1KB)

Figure 170 – Proportion of people aged 15 years and over who accessed health care, by type of health care, within the last 12 months (hospital) or last 2 weeks (other health care), by Indigenous status, and self-reported health status, age-standardised, Australia 2004–05


Figure 170 – Proportion of people aged 15 years and over who accessed health care, by type of health care, within the last 12 months (hospital) or last 2 weeks (other health care), by Indigenous status, and self-reported health status, age-standardised, A
Source: ABS and AIHW analysis of 2004–05 National Aboriginal and Torres Strait Islander Health Survey and 2004–05 National Health Survey
Text description of figure 170 (TXT 1KB)

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