Aboriginal and Torres Strait Islander Health Performance Framework (HPF) 2012

Tier 3—Accessible—3.14 Access to services compared with need

The HPF was designed to measure the impact of the National Strategic Framework for Aboriginal and Torres Strait Islander Health (NSFATSIH) and will be an important tool for developing the new National Aboriginal and Torres Strait Islander Health Plan (NATSIHP).

Page last updated: 15 November 2012

Why is it important?:

Data presented in this measure examine the level of access to health care for Aboriginal and Torres Strait Islander peoples compared with their need for health care. Indigenous Australians currently experience significantly poorer health status than non-Indigenous Australians. Their 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.

While the causes of illness and injury for any community lie in broad environmental and social factors, an effective health system has a role to play in improving health outcomes. The health system can assist with prevention through population health programs (see measure 3.03); provide an immediate response to acute illness and injury (see measure 1.02); and protect good health through screening, early intervention, and treatment (see measures 3.04 and 3.05) (Dwyer et al. 2004). Evidence from Australia, the United States and New Zealand indicate that health care can contribute to closing the gap in life expectancy between Indigenous and non-Indigenous populations (Griew 2008). Inequalities in health care access and use may act to further exacerbate inequalities in health status (OECD 2009). Access to health care when needed is therefore essential to closing the gap in life expectancy.

Findings:

Data on access to health care from population surveys covering the full spectrum of health care providers are now dated (2004–05). The next ABS survey results for the Indigenous population are expected to be available from 2013/14. Recent data for 2010–11 for health services delivered through Medicare show significant increases in health assessments claimed since the introduction of the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes. Since July 2009 there has also been an increase in GP management plan and team care arrangement services. Rates are nearly twice as high for these services for Indigenous Australians compared with non-Indigenous Australians. Rates have also increased for dental and other allied health care services claimed over this period.

In 2010–11, Indigenous Australians had 5.8 million Medicare claims of which 2.8 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 2010–11, out-of-pocket costs for services claimed through Medicare were lower for Indigenous Australians (8% of fees claimed) than non-Indigenous Australians (22% of fees claimed). Out of pocket costs were minimal for claims such as health assessments and GP management plans, and ranged from 2% for dental to 34% for specialists. 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, GP management plans, team care arrangements and dental care. Service claims for imaging, private specialists and other allied health were all lower for Indigenous Australians.

There was a clear gradient in Medicare service claims reducing by remoteness with rates per 1,000 falling for all types of services. 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 916 per 1,000 compared to 1049 per 1,000 for non-Indigenous Australians. In very remote areas Indigenous Australians claimed for private specialist services at a rate of 164 per 1,000 compared to 405 per 1,000 for non-Indigenous Australians. For non-referred GP services, Indigenous Australians claimed at a higher rate across all remoteness areas compared to non-Indigenous Australians. However, the rate difference between Indigenous and non-Indigenous Australians narrowed with increasing remoteness. The rate of non-referred GP services claimed through Medicare was lowest in the NT (4,202 per 1,000) and highest in Victoria and NSW (7,282 per 1,000 and 7,086 per 1,000 respectively). 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 15–29 and 40–65 year age group compared with non-Indigenous Australians and lower rates in the 1–14 years age groups.

There has been a steady rise in the number of Aboriginal and Torres Strait Islander primary health care services, from 108 services in 1999–2000 to 235 services in 2010–11. Between 1999–2000 and 2010–11, episodes of health care provided to clients of these services have increased by 96% from 1.22 million to 2.5 million. Equivalent full-time staff (both paid by the service and visiting) increased by 135% over the same period.

The 2004–05 survey data provide the most up to date picture of the whole health system. 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 peoples 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. In 2004–05, Indigenous Australians were more than twice as likely to visit casualty/ outpatients and half as likely to see a dentist.

Indigenous Australians were hospitalised for palliative care at 1.5 times the rate of other Australians between July 2008 and June 2010. In 2011, Indigenous Australians comprised about 1% of all patients of specialist palliative care services (Allingham 2011). In 2010–11, 46% of Aboriginal and Torres Strait Islander primary health care services offered palliative care and 47% funeral assistance.

In 2004–05, 16% of respondents felt they had been treated badly when seeking health care in the last 12 months because they were Aboriginal or Torres Strait Islander. Thirty-three per cent of respondents reported that they usually try to avoid the person/situation if they have been treated badly when seeking 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 the people reporting problems accessing services, close to 20% reported problems accessing dentists, followed by doctors (10%), hospitals (7%) and Aboriginal and Torres Strait Islander health workers (6%).Top of Page

There were a range of barriers identified to accessing health services including:
  • waiting time too long/not available at time requested (52%);
  • not enough services in area (42%);
  • no services in area (40%);
  • transport/distance (34%);
  • cost of service (32%);
  • don’t trust services (10%); and
  • services not culturally appropriate (7%).
In 2008, 18% of Indigenous Australians in remote areas had difficulty communicating with English speakers. 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. 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%). Among all Australian adults, a higher proportion of adults with insurance made a dental visit in the previous 12 months (71%) than adults without insurance (48%) (Brennan et al. 2012).

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 2009–10, waiting times for elective surgery in public hospitals at the 50th percentile (representing number of days within which 50% of people were admitted) was 38 days for Indigenous Australians compared to 35 days for non-Indigenous Australians (COAG Reform Council 2012).

Around 66% of Indigenous Australians were treated within national benchmarks for emergency department waiting times compared to 69% of other Australians. In terms of performance across triage categories, 99.6% of Indigenous Australians were treated within national benchmarks for triage category 1 (need for resuscitation), compared with 62% and 63% for triage categories 3 and 4 (urgent and semi-urgent), respectively (COAG Reform Council 2012).Top of Page

Implications:

Aboriginal and Torres Strait Islander peoples report similar rates of access to health care overall compared with non-Indigenous Australians, with differences evident by type of care. These differences are associated with factors such as cost, cultural competency, and geographic barriers. Data in this report suggest that Aboriginal and Torres Strait Islander peoples currently experience significantly poorer health and therefore we should expect to see access to health services two to three times as high rather than 1.1 times as high. 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 and preventive surgery. Barriers to accessing care when needed vary between remote and non-remote areas, suggesting that strategies need to be adapted for local circumstances.

Early findings from Medicare data show an increase in the number of health assessments, GP management plans, team care arrangements and allied health items claimed since the introduction of the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes. This Partnership Agreement includes a range of initiatives designed to support best practice management of chronic disease. Improving the identification of Indigenous clients is an important step. This will support the provision of quality health care including the provision of Indigenous specific initiatives such as MBS, PBS and immunisation programs. In May 2010 the Practice Incentives Program—Indigenous Health Incentive was introduced to support health services to provide better management of chronic disease.

As part of the 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.

Since July 2012, Australians have been able to register for a personally controlled electronic health (eHealth) record. Aboriginal and Torres Strait Islander people have been identified as a key consumer group and have been engaged in the development of the communication and training material to support adoption of the eHealth record system. The electronic health record already established in the NT is demonstrating clear benefits for consumers and health care providers by providing access to health summary information and pathology results, improving clinical decision making and increasing coordination of health care across large distances.

The Australian Government has invested $128.8 million under the Health and Hospitals Fund 2010 Regional Priority Round to provide additional patient accommodation, staff accommodation in remote areas and bringing renal dialysis and support services closer to home for patients in remote areas. The 2011 Regional Priority Round will provide $48.6 million to fund 10 Indigenous-specific projects to provide new and extended health care facilities and associated staff accommodation for regional and remote Indigenous communities.

The Australian Government also supports the Medical Specialist Outreach Assistance Program (MSOAP). This measure was introduced in 2000 to improve access for people living in rural and remote areas to medical specialist services. In recent years MSOAP has undergone three expansions, with additional funding allocated for Maternity Services Outreach, Ophthalmology Services and Indigenous Chronic Disease. These expansions broadened the MSOAP service delivery model to include multi-disciplinary team-based approaches to delivering outreach services. Under the Indigenous Chronic Disease expansion 541 services were provided in 2010–11.Top of Page
Figure 178—Comparing avoidable mortality rate ratios (2006–10) with accessing health care rate ratio (2004–05) by age group(a)(b)(c)
Figure 178—Comparing avoidable mortality rate ratios (2006–10) with accessing health care rate ratio (2004–05) by age group(a)(b)(c)

(a)Access to health care rate ratio includes hospital admissions, dental consultations, doctor consultations, casualty/outpatient visits and consultations with other health professionals
(b)Accessing health care rate ratio includes all Australian states.
(c)Avoidable mortality rate ratio includes NSW, Qld, WA, SA and the NT.
Source: 2004–05 NATSIHS and AIHW analysis of National Morbidity Database

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Figure 179—Age-standardised hospitalisation rates (excluding dialysis) by Indigenous status and remoteness, NSW, Victoria, Qld, WA, SA and the NT, July 2008 to June 2010
Figure 179—Age-standardised hospitalisation rates (excluding dialysis) by Indigenous status and remoteness, NSW, Victoria, Qld, WA, SA and the NT, July 2008 to June 2010

Source: AIHW analysis of National Hospital Morbidity Database

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Figure 180—Cumulative per cent changes to number of services, staff and episodes of care, Aboriginal and Torres Strait Islander primary health care services, 1999–2000 to 2010–11
Figure 180—Cumulative per cent changes to number of services, staff and episodes of care, Aboriginal and Torres Strait Islander primary health care services, 1999–2000 to 2010–11

Sources: SAR, DSR and AIHW OSR data collections

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Figure 181—Age-standardised MBS claim rate for non-referred GP items, by Indigenous status and state/territory, 2010–11
Figure 181—Age-standardised MBS claim rate for non-referred GP items, by Indigenous status and state/territory, 2010–11

Source: Medicare Financing & Analysis Branch, Department of Health and Ageing

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Figure 182—MBS services claimed, age-standardised per 1,000 population, by Indigenous status and remoteness, 2010–11
Aboriginal and Torres Strait Islander peoples
Figure 182—MBS services claimed, age-standardised per 1,000 population, by Indigenous status and remoteness, 2010–11—Aboriginal and Torres Strait Islander peoples

Non-Indigenous AustraliansTop of Page
Figure 182—MBS services claimed, age-standardised per 1,000 population, by Indigenous status and remoteness, 2010–11—Non-Indigenous Australians

Source: Medicare Financing & Analysis Branch, Department of Health and Ageing

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Table 47—Selected health services by type of barrier to access, Indigenous persons aged 15 years and over, 2008
Selected Health Services—Health worker—by Indigenous status
Aboriginal and Torres Strait Islander health workers—Non-remote
(%)
Aboriginal and Torres Strait Islander health workers—Remote
(%)
Aboriginal and Torres Strait Islander health workers—Total
(%)
Other health workers—Non-remote
(%)
Other health workers—Remote
(%)
Other health workers—Total
(%)
Total had problems accessing health services
5.55
5.71
5.59
2.06
4.17
2.59

Source: ABS & AIHW analysis of 2008 National Aboriginal and Torres Strait Islander Social Survey

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Selected Health Services—Health worker—By Dentist or Doctor
Dentists Non-remote
(%)
Dentists Remote
(%)
Dentists Total
(%)
Doctors Non-remote
(%)
Doctors Remote (%)Doctors Total
(%)
Total had problems accessing health services
16.94
27.41
19.55
8.61
12.30
9.53

Source: ABS & AIHW analysis of 2008 National Aboriginal and Torres Strait Islander Social Survey


Type of problems accessing health services—Health worker—by Indigenous status
Aboriginal and Torres Strait Islander health workers Non-remote
(%)
Aboriginal and Torres Strait Islander health workers Remote
(%)
Aboriginal and Torres Strait Islander health workers Total
(%)
Other health workers Non-remote
(%)
Other health workers Remote
(%)
Other health workers Total
(%)
Waiting time too long or not available at time required
48.77
44.37
47.65
51.97
51.13
51.62
Not enough services in the area
42.07
65.98
48.15
45.11
69.33
54.85
No services in the area
46.45
70.9#
52.67
42.16
67.39
52.30
Transport/distance
42.16
53.65
45.09
52.30
62.86
56.55
Cost of service
36.72
27.2#
34.30
34.73
30.0#
32.81
Don't trust services
19.79
14.5#
18.45
19.73
16.47
18.42
Services not culturally appropriate
13.51
12.3#
13.21
19.3#
13.0#
16.78

# Estimate has a relative standard error between 25% and 50% and should be used with caution.
Source: ABS & AIHW analysis of 2008 National Aboriginal and Torres Strait Islander Social Survey

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Type of problems accessing health services—Health worker—By Dentist or Doctor
Dentists Non-remote
(%)
Dentists Remote
(%)
Dentists Total
(%)
Doctors Non-remote
(%)
Doctors Remote
(%)
Doctors Total
(%)
Waiting time too long or not available at time required
58.82
41.33
52.71
67.13
49.95
61.61
Not enough services in the area
37.79
58.12
44.89
43.26
59.71
48.55
No services in the area
33.16
61.99
43.24
32.09
57.84
40.37
Transport/distance
25.19
47.58
33.01
34.73
56.53
41.74
Cost of service
48.36
19.84
38.40
39.04
21.86
33.52
Don't trust services
11.28
7.23
9.86
17.03
13.00
15.73
Services not culturally appropriate
6.96
6.14
6.67
7.8#
8.9#
8.16

#Estimate has a relative standard error between 25% and 50% and should be used with caution.
Source: ABS & AIHW analysis of 2008 National Aboriginal and Torres Strait Islander Social Survey

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Total had problems accessing health services—Hospitals, Mental health services, total (by remoteness)
Hospitals Non-remote
(%)
Hospitals Remote
(%)
Hospitals Total
(%)
Mental health services Non-remote
(%)
Mental health services Remote
(%)
Mental health services Total
(%)
Total health services Non-remote(%)Total health services Remote
(%)
Total health services Total
(%)
Total had problems accessing health services
4.00
14.48
6.61
2.79
5.53
3.47
23.03
36.42
26.36

Source: ABS & AIHW analysis of 2008 National Aboriginal and Torres Strait Islander Social Survey


Type of problems accessing health services—Hospitals, Mental health services, total (by remoteness)
Hospitals Non-remote
(%)
Hospitals Remote
(%)
Hospitals Total
(%)
Mental health services Non-remote
(%)
Mental health services Remote
(%)
Mental health services Total
(%)
Total health services Non-remote
(%)
Total health services Remote
(%)
Total health services Total
(%)
Waiting time too long or not available at time required (by remoteness)
59.60
39.28
48.52
59.37
61.43
60.19
58.13
39.65
51.77
Not enough services in the area
32.61
41.64
37.54
54.29
63.20
57.83
36.33
51.84
41.67
No services in the area
28.6#
60.70
46.13
43.80
88.27
61.46
30.08
57.38
39.48
Transport/distance
52.41
71.54
62.86
46.64
46.93
46.76
25.07
47.75
33.54
Cost of service
35.46
18.19
26.03
35.99
30.66
33.87
39.68
17.48
32.04
Don't trust services
20.22
8.75
13.96
25.05
17.87
22.20
11.26
7.66
10.02
Services not culturally appropriate
11.70
7.1#
9.18
18.2#
16.07
17.35
7.40
6.14
6.97

#Estimate has a relative standard error between 25% and 50% and should be used with caution.
Source: ABS & AIHW analysis of 2008 National Aboriginal and Torres Strait Islander Social Survey

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