Spending on primary health care for indigenous Australians is significantly less per person than for the rest of the population, despite an 11-year gap in life expectancy.
The Australian Medical Association says the new data shows mainstream primary health services are failing indigenous Australians, with services not delivering adequate care or value for money.
The Australian Institute of Health and Welfare report, commissioned by the federal government and released last Friday, shows primary health care spending for indigenous Australians is $327 per person in 2006-07 (the latest figures available), compared with $563 for non-indigenous Australians.
It also shows spending on hospital care for indigenous Australians being treated for preventable diseases such as kidney and heart disease is as much as seven times higher that of non-indigenous Australians.
AMA president Dr Andrew Pesce says the figures don’t come as a surprise. He told Crikey: “You would think there is equal access to these services for everybody and theoretically there is. But because of the lack of early access and health literacy in indigenous communities, you only see intervention when there is a crisis.
“There’s a gap in service delivery that needs to be closed in order to close the gap in life expectancy between indigenous and non indigenous people that currently stands at about 11 years.”
And the problem isn’t specific to remote communities. Dr Steve Hambleton, the AMA’s Queensland-based vice president, says 75% of indigenous Australians live in regional and metro areas, yet they are failing to access primary health care services. Recently speaking to an urban GP, Hambleton said the GP super clinic planned for that area should be an Aboriginal medical service. The GP said there are no Aboriginal people there, therefore it would be unnecessary.
“There are 4500 indigenous people living in that area, they just don’t go to the doctor,” Dr Hambleton said. “For too long this issue has been under the carpet, but it’s out there, it’s obvious and we need to do something about it.”
A spokesperson for the Department of Health and Ageing says the numbers reflect the policy of the previous government, and that Labor has put in place new policies to target these problems: “New funding arrangements under the Indigenous Chronic Disease Package provides substantial additional funding to the Aboriginal Community Controlled Health and mainstream health sectors.”
The spokesperson also said non-admitted hospital health care for indigenous Australians was 2.2 times higher than non-indigenous people, suggesting not all primary health care delivery is included in the new numbers (read the complete departmental response to Crikey here).
But policy manager at the Aboriginal Medical Service Alliance NT, Chips Mackinolty, says the most worrying figures show the level of spending for end-stage kidney disease.
“The most startling figures are on renal disease where it’s absolutely clear that the greatest cost is in end-stage renal dialysis; 45% of total hospital spending for indigenous Australians goes to renal disease each year, usually dialysis,” he told Crikey.
Mackinolty said kidney disease is one of the most expensive conditions to treat in its end stages: “Dialysis and transplants go off the charts in terms of cost. The most cost-effective thing to do would be to put money in primary health care instead of hospitals.”
But mainstream primary health care services are failing to deliver the right care, according to Dr Hambleton: “Mainstream general practices are pretty scary places for many Aborigines, but when you see an Aboriginal person at the desk, that discomfort is alleviated. Every GP can improve the way they interact with indigenous clients, but the biggest bang for buck will come from community-controlled organisations.”
More Aboriginal community-controlled health services are on the agenda for medical groups, but the problem won’t be fixed with health service improvements alone, says Mackinolty.
“Improvements in primary health care will only improve these numbers by about 30%. The other 70% comes down to social determinants of health — things like employment, housing and education,” he said.
Spending money on our indigenous fellow citizens whom most of us know very few, if any, is probably as good a subject on which to express one’s generosity.
Thanks to all sorts of taxpayer funded benefits to the retired elderly (though no one pays my sporting club fees for me: they are merely reduced by club rules) and exemptions from tax I can probably speak with some representative authority for the majority of my fellow citizens who either pay little or no tax or otherwise don’t contribute anything like what they (we) consume.
As we have the numbers I think we should make it clear that we expect our politicians, in return for their many financial and non-financial benefits which we don’t pay for but do provide our votes for whether we like it or not, to be very generous with money which is paid by actual taxpayers. And we shouldn’t be unimaginative because governments, mostly Labor, though the Muldoon government in NZ was a beauty, know how to waste money on a big scale by overpaying contractors, mismanaging contracts (surely there has to be legal redress for the Myki f**k up in Victoria) etc etc and definitely another etc. But the word “waste” is insensitive because if we want to spread the much around (extracted from real living and corporate taxpayers) we should be happy that nice politicians want some to go to the hopelessly incompetent or congenitally negligent who, after all, are unlikely to qualify for that largesse and celebrity which goes to our splendid athletes who can beat Indians at weight lifting (especially those we have bought from Bulgaria).
So, generosity is the order of the day, and please keep up the subsidies for my opera tickets. I know they are subsidised because the ones that are the most expensive bear GST as well because they are unsubsidised. I know my plea will be heard because my generous taxpaying children are providing well enough for the arts that the board of the opera is able to afford to give free seats to many conscientious politicians who haven’t the time, just for a few days, to take a trip to Paris or New York.
Oh what a wonderful world!
And for the next miracle look for a worthy person writing to the Fairfax press who recognises that there might even be a justified Tea Party sentiment in this country which elects the representatives of Howard battlers and is only non-toxic because G*d has blessed us with China and miners so we can all feel that when we put our hands out we are getting a bit that we don’t deserve. (Oh, don’t tell me you think the only pleasure is to be obtained by people genuinely believing they deserve the good things they get).
I am confused Jefferson, for example who are you referring to by “the hopelessly incompetent or congenitally negligent”? Is this referring to the Indigenous peoples of Australia? Your comment is not clear.
And while I am no big fan of our current Labor government, are you really trying to suggest that the Mad Monk Mr Rabbid or Bumbling Ted Balieu have the slightest shred of competency or honesty between them? After Tampa, children overboard etc and Balieu’s policy gymnastics I think such assertions would be difficult to uphold!
Aboriginal health will not begin to be fixed until children are taken by their parents to central school with hostel , to remove them from alcohol, drugs, abuse, dirt and unhealthy food, and truancy…
This must commence with kindy kids, and nothing will improve the hopelessness of aboriginal life until we bite the bullet and starts with early school age children .
It’s fine for Pearson to pick bright kids and send them to private boarding schools in cities, and for Waverley to do the same for bright primary children, but it is the majority who are not being given a chance.
Stop telling us how bad it is and make someone do something as basic as looking after the young.
Joan Croll
Oh my goodness Joan, listen to your self. Do you really beleive that all Aboriginal parents are abusive or negligent? That is absolute rubbish.
We are only just recovering from the assimilationist policies of the past and trying to justify taking the children away yet again is lunacy. Improving health by removing children from their family and culture? You cannot seriously believe that would work.
@OwentheWorld
Oh no! The “hopelessy incompetent or congenitally negligent” that I have in my sympathetic sights are not the indigenous (though they are welcome in the club I am sure) but the kind of people who botch the contracted work for governments. At least when our great miners do as badly it is willing shareholders (or their superannuation trustees for them) who are hit not voters as such who wouldn’t normally have picked their politicians (or the career bureaucrats) to spend big money on their behalf.