Evidence points to a “good return” from funding comprehensive primary care services for Indigenous people
This issue of the Journal showcases the work of health services in Aboriginal and Torres Strait Islander health care settings across Australia. The research reported provides clear indication of where funding is likely to improve the health of Indigenous peoples. It also creates an economic imperative for action, in addition to the social justice arguments made elsewhere.1
The health care gaps highlighted require policy responses and long-term financial investment. However, there is uncertainty over the ongoing funding of many Closing the Gap initiatives as well as Aboriginal community controlled health services (ACCHSs) and Medicare Locals. There is also no certainty to the future of the National Aboriginal and Torres Strait Islander Health Plan 2013–2023.2
Panaretto and colleagues describe outcomes achieved by ACCHSs3 among a population poorly served by the health system.4 They see the ACCHS model of comprehensive, holistic, ongoing primary care as being akin to the medical home model widely espoused in Australia and internationally.5 They also note that its benefits in terms of employment are an important contributor to the economic benefits of ACCHSs.6
Two studies from the Northern Territory show the need for increased investment in Indigenous primary health care. Using a rigorous mixed-methods approach in a remote clinic, Gador-Whyte and colleagues estimated that providing the recommended standard of care for patients with type 2 diabetes and chronic kidney disease would require a 44% increase in funding (an additional $1733 per patient per annum).7 Thomas and colleagues suggest that covering such a shortfall would be cheaper than picking up the costs in the hospital setting. Their analysis showed that for patients with type 2 diabetes, each dollar invested in primary care could save up to $12.90 in hospital costs.8
In their study of 24 “sentinel sites” around Australia, Bailie and colleagues found that despite increasing rates of Aboriginal and Torres Strait Islander health assessments, the follow-up needed to improve health outcomes was not being consistently taken up.9 This further illustrates the importance of supporting the development of primary health systems, as does a recent systematic review showing benefit from health checks by the patient's usual primary care doctor.10 Bailie et al call for health service support “in developing systems and organisational capability to undertake follow-up of health assessments, but more importantly to reorient to high-quality, population-based and patient-centred chronic illness care” — the sort of care that requires increased investment in primary health care.7
The local and international evidence is unequivocal: affordable, effective and equitable health care requires well supported, comprehensive primary health care. The ACCHS model achieves these outcomes. What is required now is ongoing commitment to targeted funding by state and federal governments, starting with implementation of the National Aboriginal and Torres Strait Islander Health Plan;2 commitment to ongoing long-term funding for Closing the Gap initiatives; and long-term investment in services delivering primary health care to all Aboriginal and Torres Strait Islander people — in particular, ACCHSs. This is not only required for equitable health care but also makes sound economic sense.
This investment is clearly a critical issue in light of the proposed federal Budget cuts to Aboriginal and Torres Strait Islander health initiatives.11 There is also clear evidence that out-of-pocket costs have a direct impact on access to health care.12 The GP copayment will pose a barrier to accessing the level of primary health care suggested by Thomas et al as being likely to save hospital costs. We hope it is not too late for a commitment to ongoing long-term funding for Closing the Gap initiatives and long-term investment in primary health care delivery to all Aboriginal and Torres Strait Islander people.
Provenance: Commissioned; externally peer reviewed.
- 1. Aboriginal and Torres Strait Islander Social Justice Commissioner. Achieving Aboriginal and Torres Strait Islander health equality within a generation — a human rights based approach. Sydney: Human Rights and Equal Opportunity Commission, 2005. https://www.humanrights.gov.au/publications/achieving-aboriginal-and-torres-strait-islander-health-equality-within-generation-human (accessed May 2014).
- 2. Australian Government. National Aboriginal and Torres Strait Islander Health Plan 2013–2023. Canberra: Commonwealth of Australia, 2013. http://www.health.gov.au/natsihp (accessed May 2014).
- 3. Panaretto KS, Wenitong M, Button S, Ring IT. Aboriginal community controlled health services: leading the way in primary care. Med J Aust 2014; 200: 649-652. <MJA full text>
- 4. Australian Bureau of Statistics. The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples, Oct 2010. Canberra: ABS, 2011. (ABS Cat. No. 4704.0.) http://www.abs.gov.au/AUSSTATS/abs@.nsf/lookup/4704.0Chapter955Oct+2010 (accessed May 2014).
- 5. Rosenthal TC. The medical home: growing evidence to support a new approach to primary care. J Am Board Fam Med 2008; 21: 427-440.
- 6. Alford K. Economic value of Aboriginal community controlled health services. Canberra: National Aboriginal Community Controlled Health Service, 2014. http://nacchocommunique.com/2014/04/02/economic-value-of-aboriginal-community-controlled-health-organisations (accessed May 2014).
- 7. Gador-Whyte AP, Wakerman J, Campbell D, et al. Cost of best-practice primary care management of chronic disease in a remote Aboriginal community. Med J Aust 2014; 200: 663-666. <MJA full text>
- 8. Thomas SL, Zhao Y, Guthridge SL, Wakerman J. The cost-effectiveness of primary care for Indigenous Australians with diabetes living in remote Northern Territory communities. Med J Aust 2014; 200: 658-662. <MJA full text>
- 9. Bailie J, Schierhout GH, Kelaher MA, et al. Follow-up of Indigenous-specific health assessments — a socioecological analysis. Med J Aust 2014; 200: 653-657. <MJA full text>
- 10. Si S, Moss JR, Sullivan TR, et al. Effectiveness of general practice-based health checks: a systematic review and meta-analysis. Br J Gen Pract 2014; 64: e47-e53.
- 11. Australian Government. Budget 2014–15. Part 2: Expense measures. Prime Minister and Cabinet. http://www.budget.gov.au/2014-15/content/bp2/html/bp2_expense-20.htm (accessed May 2014).
- 12. Doggett J. Empty pockets: why co-payments are not the solution. Canberra: Consumers Health Forum of Australia, 2014. https://www.chf.org.au/pdfs/chf/Empty-Pockets_Why-copayments-are-not-the-solution_Final-OOP-report.pdf (accessed May 2014).
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