Volume 193 - Issue 3
Invisible people?
Authors: Nicholas G Lennox and James C Simpson
Med J Aust 2010; 193 (3): 185. || doi: 10.5694/j.1326-5377.2010.tb03847.x
Published online: 2 August 2010
Published online: 2 August 2010
To the Editor: The current political debate on health reform has made no mention of the 300 000 people who were identified by the National Health and Hospitals Reform Commission as facing “stark health inequalities”.1 We refer to people with intellectual disability, who face a life expectancy 5–20 years shorter than people in the general population, substantial unmet health needs and significant barriers to getting these needs met.
A recent review of health inequalities in England states:
To reduce the steepness of the social gradient in health, actions must be universal, but with a scale and intensity that is proportionate to the level of disadvantage. We call this proportionate universalism.2
In its health reform initiatives, the federal government has quite rightly included specific funding for the health of Indigenous people and residents of aged care facilities, and for rural health and mental health. Many of these measures are just a start, but they are direct acknowledgement of specific disadvantage. However, the government has taken no such action on the health of people with intellectual disability.
In fact, recent changes to Medicare (in May 2010)3 include a step backwards for people with intellectual disability. The merging of intellectual disability health assessment items into four new time-based items means that data are no longer kept on the uptake of intellectual disability assessments. This was the one piece of information on the health of people with intellectual disability that the government collected.
Many of the government’s health reforms will have wide community benefit. However, we are long used to people with intellectual disability missing out on the benefits of generic programs. To give one example, funding hospitals on the basis of the “efficient price” of services may create a disincentive to treat people with intellectual disabilities, who need much more time than other patients. To avoid this disincentive, the government needs to create a price-loading for people with intellectual disability, which in turn will require the government to redress the absence of data on hospitalisations of people with intellectual disability. With each plank of its reform, the government at least needs to ask: “What adjustments are needed to make this work for people with intellectual disability?” We are happy to provide the answers.
Competing interests
Nicholas Lennox is the developer of the Comprehensive Health Assessment Program, a copyright product of the University of Queensland, the licence for which is distributed between the University and Professor Lennox.
References
- National Health and Hospitals Reform Commission. A healthier future for all Australians — National Health and Hospitals Reform Commission final report June 2009. Canberra: Commonwealth of Australia, 2009. http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/nhhrc-report (accessed May 2010).
- Marmot M (Chairman). Fair society, healthy lives. Strategic review of health inequalities in England post-2010 (the Marmot Review). London: The Marmot Review, 2010: 15. http://www.marmotreview.org/AssetLibrary/pdfs/Reports/FairSocietyHealthyLives.pdf (accessed May 2010, link updated Jul 2010)
- Australian Government Department of Health and Ageing. The changes to Medicare primary care items. A fact sheet for general practitioners. Canberra: Commonwealth of Australia, 2010. http://www.health.gov.au/internet/main/publishing.nsf/Content/mbsprimarycare-changes-to-medicare-primary-care-items-for-gps (accessed Jun 2010).