Executive summary—Tier 3: Health System Performance

Improvements

Chronic disease detection and management

• There has been a significant increase in a range of Medicare Benefits Schedule (MBS) services claimed by Aboriginal and Torres Strait Islander peoples for identifying and managing chronic disease since the introduction of the Indigenous Chronic Disease Package under the National Partnership on Closing the Gap in Indigenous Health Outcomes.
• Although the number of health assessments provided each year has been increasing steadily, the increase is significantly greater since July 2009 than in previous years (see Figure 4 below).
• There has also been an increase in the number of GP management plans and team care arrangements claimed by Indigenous Australians through Medicare over this period. Rates are higher for these services for Indigenous Australians than non-Indigenous Australians. There has also been a corresponding increase in a range of allied health items linked to health assessments and management plans/team care arrangements including a number of other allied health services and dental services (with 98% of these dental services bulk billed).

Figure 4—Rate per 1,000 persons receiving Medicare Benefits Schedule Health Assessments, by age group, Indigenous Australians, 2006 to 2011

Access to prescription medicines

• The National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes has increased access to pharmaceuticals. Up to 30 June 2012, 150,005 eligible Aboriginal and Torres Strait Islander patients have benefited from the Closing the Gap Pharmaceutical Benefits Scheme (PBS) Co-payment Measure and 5,127 (96%) pharmacies have participated in the measure. A prescription volume of 2,729,929 has been dispensed since the measure commenced in July 2010.Top of page

Increased availability of Indigenous-specific services

• Australian Government Indigenous-specific health program expenditure increased from $115 million in 1995–96 to $624 million in 2010–11, a growth in real terms of 265%. There has been a 96% increase in episodes of care delivered through Aboriginal and Torres Strait Islander primary health care services (from 1.22 million in 1999–2000 to 2.5 million in 2010–11).

Usual source of care

• Having a usual primary care provider is associated with good communication between the patient and provider, greater trust in the health care provider, improved preventive care and better health outcomes. Statistics from 2004–05 indicate that 91% of Indigenous Australians usually went to the same GP or Aboriginal medical service.
• In 2008, 80% of Aboriginal and Torres Strait Islander peoples aged 15 years and over agreed that their doctor could be trusted.

Antenatal care

• The proportion of Aboriginal and Torres Strait Islander women accessing antenatal care at least once during pregnancy has increased in NSW, Qld and SA combined between 1998 and 2009. In 2009, 97% of Aboriginal and Torres Strait Islander women accessed antenatal care at least once during their pregnancy.

Immunisation coverage for children

• Immunisation rates are high for Indigenous children. By 2 years of age, coverage rates are close to those for other Australian children (92.3% of Indigenous children compared with 92.6% for other children).

Resources

• On a per capita basis, average health expenditure for Aboriginal and Torres Strait Islander peoples in 2008–09 was $1.39 for every $1.00 spent per non-Indigenous Australian. This has increased since 1995–96 where the rate was $1.08 per $1.00.

Continuing concern

Barriers to accessing health care

• In 2008, 26% of Aboriginal and Torres Strait Islander peoples aged 15 years and over reported problems with accessing health services. Access issues were higher in remote areas (36%) than non-remote areas (23%). Of those who had problems accessing health services, close to 20% reported having problems accessing dentists, followed by doctors (10%), hospitals (7%) and Aboriginal and Torres Strait Islander health workers (6%).
• Selected potentially preventable hospitalisation rates for Aboriginal and Torres Strait Islander peoples were five times the non-Indigenous rate during the period July 2008 to June 2010.
• Aboriginal and Torres Strait Islander peoples had lower rates of hospitalisations with a procedure recorded compared with non-Indigenous Australians, and they also had lower rates of elective surgery.
• Discharge from hospital against medical advice was five times the rate for Indigenous Australians compared with non-Indigenous Australians.Top of page

Aboriginal and Torres Strait Islander health workforce

• In 2006, 1.2% of the Indigenous population was employed in health-related occupations compared with 3% of the non-Indigenous population. The occupations with the largest gap between Indigenous and non-Indigenous Australians were nurses, medical practitioners and allied health professionals.
• Aboriginal and Torres Strait Islander peoples are also under-represented in training for various health professions. Improving participation in training for health professions is a key priority across a broad range of disciplines including medicine, nursing, allied health and Aboriginal health workers.
• Health workforce issues also extend to ensuring there is an effective workforce to support improved Aboriginal and Torres Strait Islander health. The HPF finds recruitment and retention issues relevant to both Indigenous-specific health services and mainstream services.
• In 2010–11 there was a decline in full time equivalent GPs as remoteness increased, with 70% based in major cities and 0.5% in very remote areas.

Antenatal care

• Antenatal care for Indigenous women occurs later and less frequently than for non-Indigenous women. In 2009, in NSW, Qld, SA and the NT, 56% of mothers had their first antenatal session in the first trimester of the pregnancy, compared with 75% of non-Indigenous mothers.

Resources

• The additional rate of expenditure per person for Aboriginal and Torres Strait Islander peoples compared to other Australians (39%) is lower than the disparity in illness and mortality (200%).
• In non-remote areas, 15% of Indigenous Australians were covered by private health insurance compared with 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%). Lower rates of private health insurance contribute to reduced access to services, in particular dental, allied health, specialist services and private hospitals. In the two years to June 2008, 6% of hospitalisations with a procedure recorded for Indigenous Australians occurred in private hospitals compared with 50% for non-Indigenous Australians.

Access to prescription medicines

• In 2008–09, average expenditure on pharmaceuticals per Aboriginal and/or Torres Strait Islander person was around 44% of the amount spent per non-Indigenous person ($315 compared with $710). In 2001–02, per person pharmaceuticals expenditure was estimated to be 33% of the amount spent on non-Indigenous Australians. This suggests that the gap in spending between Indigenous and non-Indigenous Australians is closing.

Access to health care

• In 2004–05, 42% of Aboriginal and Torres Strait Islander peoples reported accessing health care in the previous two weeks (or 12 months for hospital admissions). This rate is similar to the non-Indigenous rate, but lower than expected given the greater burden of illness experienced by Aboriginal and Torres Strait Islander peoples.
• Aboriginal and Torres Strait Islander peoples were twice as likely to visit casualty/outpatients in a hospital and half as likely to see a dentist in 2004–05. Barriers to accessing care included cost, cultural competence, transport and availability.
• Expenditure estimates show higher rates for Indigenous Australians for public hospital use and community health services and lower rates for medical services through the MBS (including GP services), dental services, and medications compared with non-Indigenous Australians.
• In 2006, the health occupation with the largest number of Indigenous Australians was nursing (1,449), followed by nursing support and personal care workers (974), and Aboriginal and Torres Strait Islander Health Workers (966).

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