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.

Peter Fray

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Peter Fray
Editor-in-chief of Crikey