” Primary care policy needs an overhaul to ensure all Australians — especially the poor and the elderly — get the best possible health care, according to a new Grattan Institute report.

Mapping primary care in Australia shows many poorer Australians can’t afford to go to a GP when they need to or a dentist when they should, and people in rural and remote areas find it too hard to get to a pharmacist or medical specialist. “

Stephen Duckett, Health Program Director Grattan Institute see in full Part 1 below

” Primary health care for Aboriginal and Torres Strait Islanders (ATSI) is delivered by a range of providers, including ATSI specific and general health service organisations.

The Indigenous Australians Health Programme105 provides Aboriginal and Torres Strait Islander people with access to primary care services in urban, rural and remote locations, primarily through Aboriginal and Community Controlled Health Services.

Commencing in 2015-16, the Commonwealth committed $3.2 billion over four years to fund the Indigenous Australians Health Programme.

The programme funds primary care services, remote area health, and integrated team care. It targets a range of infectious, chronic and behavioural conditions that are particularly relevant for indigenous populations.

Data on the outcomes of Indigenous health services is better than for many other primary care services.

Most outcomes have improved over the last few years, although they remain well behind averages for the rest of the population.

See Pages 30 – 32 in the Grattan Report Download full report HERE

Grattan Institute -Mapping-primary-care

Part 1

Australians’ access to general practice varies according to their wealth. Two-thirds of patients are bulk-billed for all their visits to the GP, but the financial barriers for those who are not can be high. About 4 per cent of Australians say they delay seeing a GP because of the cost.

Individuals or their private health insurer have to pay for the bulk of dental care. As a result, about one in five Australians do not get the recommended level of oral health care. Worse, people on low incomes who can’t afford to pay often wait for years to get public dental services.

Access to allied health services such as physiotherapy and podiatry varies significantly according to where people live. People in the Northern Territory are about four times less likely to use Medicare-funded allied health services than Victorians.

The report finds that the funding, organisation and management of primary care has not kept pace with changes to disease patterns, the economic pressure on health services, and technological advances.

In particular, primary care services are not organised well enough to support integrated, comprehensive care for the 20 per cent of Australians who have complex and chronic conditions.

Nor is primary care well organised to prevent or reduce the incidence of conditions such as type 2 diabetes and obesity.

Governance and accountability are split between various levels of government and numerous separate agencies, making overall management of the system difficult. Neither the Commonwealth nor the states take the lead.

The report calls for:

• A comprehensive national primary care policy framework to improve prevention and patient care.
• Formal agreements between the Commonwealth, the states and Primary Health Networks to improve management of the primary care system.
• New funding, payment and organisational arrangements to provide better long-term care for the increasing number of older Australians who live with complex and chronic conditions, and to help keep populations healthy in the first place.

“Primary care policy in Australia is under-done,” says Grattan Institute Health Program Director Stephen Duckett.

“Australia has good-quality primary care by international standards, but it can be better. This report shows how.”

PART 2 Aboriginal and Torres Strait Islander health

5.1 Aboriginal and Torres Strait Islander health practitioners

According to National Health Workforce data, there were 451 ATSI health practitioners in 2015. As Figure 5.1 shows, most work in outer regional, remote and very remote areas,106 and as Figure 5.2 on the next page shows, most work in Aboriginal health services.

These services provide a comprehensive range of medical, oral, nursing and allied health services for Aboriginal and Torres Strait Islander people tripled to around 50 per cent. Recording of blood pressure, blood sugar levels and kidney function also increased.

Results indicate that Aboriginal and Torres Strait Islander health services are on track to meet national goals by 2023, although results vary according to jurisdiction and remoteness.

All improvements must be considered in the context of the big gap in health outcomes between Indigenous and non-Indigenous Australians.

The life expectancy of Indigenous Australians is about 10 years shorter than for other Australians.

5.2 Indigenous primary health services

In 2015-16, there were 204 Indigenous primary health care services.

They employed 7766 full-time equivalent staff, of whom 53 per cent were Indigenous. They had about 5.4 million contacts with 461,500 patients. The vast majority of patients (79 per cent) were Indigenous.

As Table 5.1 shows, most of these services (69 per cent) are in outer regional, remote and very remote areas, and a similar proportion are Aboriginal Community Controlled Health Organisations (ACCHOs).108

5.3 Performance measurement

Significant effort has been made to measure the impact of primary care services on the health of Aboriginal and Torres Strait Islander people.

The 24 National Key Performance Indicators for Aboriginal and Torres Strait Islander Health109 cover maternal and child health, preventative health and chronic disease management. They build on previous work including the Australian Primary Care Collaboratives Program.

The 2016 results indicated significant improvement on 12 of the 16 measures in the national minimum data set.

This included improvements in recording patients’ birth weight, alcohol consumption, and whether they smoke.

But outcome measures indicated high and increasing levels of chronic disease and chronic disease risk factors among patients from 2012 to 2016.

There were indications that coordination of the care of patients had improved. From 2012 to 2015, the proportion of patients with diabetes who had GP management plans and team care arrangements had tripled to around 50 per cent.

Recording of blood pressure, blood sugar levels and kidney function also increased.

Results indicate that Aboriginal and Torres Strait Islander health services are on track to meet national goals by 2023, although results vary according to jurisdiction and remoteness.

All improvements must be considered in the context of the big gap in health outcomes between Indigenous and non-Indigenous Australians.

The life expectancy of Indigenous Australians is about 10 years shorter than for other Australians.110

5.4 Funding

In 2013-14, about $6 billion was spent towards improving Indigenous health, of which 13 per cent went to community health services.111

The Commonwealth has introduced a range of measures to improve Indigenous Australians’ access to health care, including MBS and PBS concessions for Indigenous patients and deploying Medicare liaison officers to educate Indigenous people about the health care system.112

Available data suggests the distribution of Commonwealth-funded ATSI health services and other GP services matches the distribution of Indigenous populations, except in remote and very remote areas of Queensland and Western Australia.113

But more data is needed, including on services provided by state and territory governments, and on the quality of the coordination of care for Indigenous patients.

The available data also suggests Indigenous Australians may have poorer access to specialist services. And of course, access to a service does not ensure that the care provided is culturally appropriate.