• Lesley Russell

02 November 2010The policy has failed, writes Lesley Russell. Here's what needs to be done to fix it

AS THE EVIDENCE mounts that efforts to “Close the Gap” in Indigenous disadvantage are faltering, and with the recognition that much more is needed to tackle the health care needs across all Indigenous communities, we are confronted with evidence that a key mechanism for uncovering and addressing health problems is ineffectual.

Health assessment or health check items – under which Medicare will reimburse for preventive health services to Indigenous patients – were introduced in 1999, when a Medicare Benefits Schedule (MBS) item for an annual health check for Aboriginal and Torres Strait Islander peoples aged 55 years and older was implemented. In 2004 a new item was introduced for biennial health assessments among adult Aboriginal and Torres Strait Islander people aged 15 to 54 years. The Aboriginal and Torres Strait Islander Child Health Check for children under 15 years of age has been in place since May 2006.

In comparison with other MBS preventive services, these items were well reimbursed, generally offering a GP between $175 and $200. Nevertheless, the uptake of these items, especially if considered in light of the acknowledged need and the loudly voiced support of doctors’ groups for Indigenous health, has been shamefully low.

As a consequence, the lives of children are blighted by preventable infectious diseases, young adults remain ignorant of their risk of diabetes and the harm from substance abuse, and elders die far too young from the consequences of undiagnosed and untreated chronic conditions. These facts are as true for the Indigenous populations of Perth and inner Sydney as they are for those in country towns in New South Wales and Victoria and for the remote communities in central Australia.

In May 2010, under the rubric of easing red tape and paperwork for doctors, a number of changes were made to the Medicare Benefits Schedule. As part of these changes, a single item number was introduced for health assessments for Indigenous Australians. It appears that all references to the older items have disappeared from the Medicare Australia website. But it is still possible to track services delivered under these items by looking at the breakdown by age, sex and state for each time period, although it’s a time-consuming exercise, and deriving some data is no longer possible for the outside researcher.

Every year over 400,000 Indigenous Australians are entitled to receive a Medicare heath check. In 2009–10 less than 12 per cent of the eligible population got such a check. And despite the emphasis placed on children’s health and the ongoing Northern Territory Emergency Response (NTER), data show that in the Northern Territory in 2009–10 only 12.7 per cent of children aged under 15 got a health check.

On top of this, there are no measures in place to ensure that health problems uncovered in the course of health checks are addressed in a timely fashion. There is very little information about this follow-up, but published data suggests that about 80 per cent of health checks show health problems that need treatment or referrals. Even in the NTER communities, with allocated funding for the purpose, the delivery of follow-up care has lagged.

The federal government must move quickly to implement and fund an improved program for health assessments across all age groups, including a system to ensure that all health problems found as a consequence of a health check are appropriately addressed and resolved. Serious consideration should be given to a requirement in law that the federal government funds and ensures the delivery of these needed services. A good model is the Early Periodic Screening, Diagnosis and Treatment component of the United States’ Medicaid program. At the very least there should be a requirement that all follow-up services are documented through to resolution.

Finally it is imperative that resources are provided for the independent, transparent monitoring and evaluation of this new program. The current situation where the Department of Health and Ageing exhibits no interest in regularly assessing the effectiveness of its own programs and the publicly available data are increasingly limited, means that problems remain hidden and good money is thrown after bad on programs that do not work.

Time is ticking away in the government’s self-imposed timeframes on the commitments made in 2008 to closing the life expectancy gap within a generation and halving the gap in mortality rates for Indigenous children under five within a decade. No one – least of all our Indigenous citizens – can afford a major health care policy that is not working. •
 
A detailed analysis of the use of Indigenous health checks is available here.

Lesley Russell is a Senior Fellow at the Center for American Progress in Washington DC. She is a Research Associate at both the Menzies Centre for Health Policy and the US Studies Centre at the University of Sydney.