The RACGP strongly believes that the primary healthcare sector holds the key to more rapid and sustainable improvements to Aboriginal and Torres Strait Islander health. Evidence supports that effective primary healthcare systems are associated with better health outcomes and lower national healthcare costs.
Expenditure on primary healthcare for Aboriginal and Torres Strait Islander communities has increased since the 1990s, but these increases are not sufficient to overcome the high burden of morbidity and mortality in this population. Australian Institute of Health and Welfare (AIHW) data from 2010–2011 showed that per person Medicare Benefits Schedule (MBS) expenditure for Indigenous Australians was only $493 compared with non-Indigenous Australians at $737. In order to reduce the gap in health status and life expectancy between Aboriginal and Torres Strait Islander people and non-Indigenous Australians, this expenditure gap needs to close.
General practitioners (GPs) play a key role in delivering primary care, and in Australia, have been supported to help improve Aboriginal and Torres Strait Islander health outcomes by a range of government initiatives. These include preventive healthcare checks, improved Indigenous access to Pharmaceutical Benefits Schedule (PBS) medicines, specific immunisations for Aboriginal and Torres Strait Islander people, referrals to specific services and the Practice Incentives Program (PIP) Indigenous Health Incentive (IHI). However, evidence shows that the uptake of these GP-mediated targeted healthcare interventions has been sub-optimal.
Position of the RACGP
Aboriginal and Torres Strait Islander people have the right to be provided with clinically and culturally appropriate healthcare wherever they present. For this reason, the RACGP strongly endorses the inclusion of private general practices in initiatives to help close the gap between non-Indigenous and Aboriginal and Torres Strait Islander health outcomes. Aboriginal Community Controlled Organisations (ACCHSs) provide a vital service and are often located in areas where no general practices exist. However, ACCHSs are not geographically accessible for every Aboriginal and/ or Torres Strait Islander Australian and patients have the right to preference a different service.
Many GPs, especially those working in private general practices, do not fully understand the range of GP-mediated health programs designed specifically for Aboriginal and Torres Strait Islander people.
There are several possible reasons for this:
- Many practices believe that they have no Aboriginal and/or Torres Strait Islander people attending their practice.
- Many general practices that are eligible for initiatives such as the PIP IHI are unaware of its existence, feel that they have too few Aboriginal and/or Torres Strait Islander people attending their practice, or believe that the paperwork required is too onerous and not worth their while.
- Different Aboriginal and Torres Strait Islander-specific health interventions are administered by different Government agencies or departments and have not been presented as a consolidated whole to GPs, resulting in considerable confusion for doctors about what is available.
There must be greater emphasis on communication to enhance the awareness of healthcare providers on Aboriginal and Torres Strait Island health needs and initiatives, and to promote greater awareness amongst eligible patients of what they can access and why. Aboriginal and Torres Strait Islander people are more likely to disclose their Indigenous status to their healthcare service if they understand what the healthcare benefits are available to them.
The vital issue is that patients need to feel comfortable entering a practise to seek healthcare. Once there, they need to be identified as Aboriginal and Torres Strait Islander patient and have access to healthcare professionals who recognise and include cultural difference in their care planning. The RACGP supports an outcome where every health service or private general practice in Australia can provide appropriate care to Aboriginal and Torres Strait Islander patients.