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Fears co-payment, Budget cuts could widen Indigenous health gap

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Many Indigenous people are putting off seeing their doctor because of cost, contributing to extraordinarily high rates of preventable hospitalisation and premature death among Indigenous Australians, the peak adviser to the nation’s governments has warned.

In a finding that has added fuel to the debate over the Federal Government’s controversial $7 co-payment, the COAG Reform Council’s final report card on Indigenous health showed that 12.2 per cent of Indigenous adults delayed or cancelled a trip to their GP because of cost – an outcome linked by Council Chair John Brumby to higher rates of ill health, preventable hospitalisation and premature death.

“When you avoid going to a primary or community care provider because of cost or other reasons, you often end up in hospital,” Mr Brumby said. “And we’ve found that rates of preventable hospitalisations for Indigenous Australians are three to four times higher than for non-Indigenous Australians.”

AMA President Associate Professor Brian Owler said the finding underlined doctor concerns about the impact of the proposed $7 co-payment.

A/Professor Owler said the fact that a significant proportion of Indigenous people already put off seeing their doctor when the national bulk billing rate was around 82 per cent did not bode well for when the co-payment came into effect and the bulk billing rate dropped.

The AMA President said it showed how important it was to recognise that Indigenous health was not just a matter for targeted programs and services, but was also affected by broader developments in the health system.

Aboriginal and Torres Strait Social Justice Commissioner Mick Gooda said the proposed co-payment was a cause of “great anxiety” about Indigenous health.

“Aboriginal and Torres Strait Islander people access Medicare services at a rate which is almost one third lower than what is required on a needs basis,” Mr Gooda wrote on the ABC’s The Drum blog. “Our people need encouragement to access medical services, not more barriers.”

The Federal Government’s commitment to improving Indigenous health has been called into question following funding cuts to health programs, as well as the introduction of the $7 co-payment.

The Government has rejected such criticisms, and late last month Assistant Heath Minister Senator Fiona Nash announced that work was to begin on implementing the National Aboriginal and Torres Strait Islander Health Plan as part of efforts to raise the health standards of Indigenous Australians and bring them into line with the broader community.

“The Health Plan provides a useful framework to guide policy and program development,” Senator Nash said, adding that it would recognise the links between health, education, employment and community safety. “The Government is committed to closing the gap by ending the cycle of disadvantage which starts with poor child health. Indigenous health will only be improved by concrete action on the ground.”

But a $165.8 million cut to funding for Indigenous health programs in the May Budget has undermined the Government’s message and raised questions about the seriousness of its intent to close the health gap.

In highlighting the size of the task confronting governments, the COAG Reform Council found that while substantial progress had been made in reducing child mortality rates, there remained formidable disparities in health outcomes.

The rate of preventable hospitalisations was three times higher among Indigenous people than the national average, while a shocking 75 per cent of deaths of Indigenous people younger than 75 years could have been avoided through preventive care or early treatment.

Adding to the disturbing picture, the Australian Institute of Health and Welfare has reported that Indigenous adults were twice as likely to die from coronary heart disease as the broader population, and three times as likely to succumb to chronic obstructive pulmonary disease. The rate of COPD in the Indigenous community is more than twice that of the national average.

The stark figures have contributed to the yawning gap in life expectancy – on average, Indigenous men are likely to die 10 years earlier than their non-Indigenous countrymen, while among women the life expectancy gap is greater than nine years, according to the COAG report.

In a disappointing assessment, the COAG Reform Council warned that the goal to close the large life expectancy gap by 2031 was unlikely to be met.

“These things scream out that change is needed,” A/Professor Owler said. “We have got lots of information on what the problems are. We now need to act and make changes.”

A/Professor Owler said there were already many examples of local health services that had achieved significant improvements in Indigenous health in their areas through innovative and targeted programs, and groups like National Aboriginal Community Controlled Health Organisations (NACCHO) were working hard on ways to adapt and apply such successes in other areas.

He said any cuts to program funding in the name of efficiency had to be very carefully considered and evaluated, and should only be made in close consultation with those providing Indigenous health services.

Mr Brumby delivered the findings of the COAG report to the NACCHO annual summit on 26 June.

NACCHO Chair Justin Mohamed said that although there were some signs of improvement in Indigenous health, Federal Budget cuts and health policy changes put further progress at risk.

“We are really worried that the millions of dollars being cut from across Aboriginal affairs at the Federal level, plus the introduction of new arrangements in accessing primary health care and changes to unemployment benefits, could potentially push the closing the gap targets even further from reach,” Mr Mohamed said.

The NACCHO Cahir lamented the abolition of the COAG Reform Council, in whose absence there would be “no independent umpire able to evaluate progress – or the lack of it – and hold governments accountable”.

Adrian Rollins