In reply: The letter from Coffey and colleagues helps make my case that a major role for Aboriginal community controlled health organisations (ACCHOs) in providing health care to Indigenous communities makes a real difference in the effectiveness and efficiency of service delivery. However, we cannot be certain that the progress made in reducing Indigenous mortality rates in the Northern Territory is the result of better health care; it may reflect improvements in the social determinants of health, such as education, housing and community violence.
Hospital data highlight that success is still a long way off. The ratio of Indigenous to non-Indigenous aged-standardised hospital separations for the NT is 7.9, compared with 2.5 for all jurisdictions.1 There is a clear relationship between the number of primary care visits and hospitalisation for Indigenous residents of the Territory who live in remote communities. For patients with diabetes, ischaemic heart disease and renal disease, around 22 to 30 primary care visits a year are needed to reduce hospitalisations to a minimum.2 That is why an increased role for ACCHOs is one of the keys to closing the gap.
- 1. Australian Indigenous HealthInfoNet. Overview of Australian Indigenous health status 2012. http://www.healthinfonet.ecu.edu.au/uploads/docs/overview_of_indigenous_health_2012.pdf (accessed Feb 2014).
- 2. Zhao Y, Wright J, Guthridge S, Lawton P. The relationship between number of primary health care visits and hospitalisations: evidence from linked clinic and hospital data for remote Indigenous Australians. BMC Health Serv Res 2013; 13: 466. http://www.biomedcentral.com/1472-6963/13/466 (accessed Feb 2014).
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