• Lesley Russell, Aboriginal welfare quarantine 'like apartheid'
• Menzies Centre for Health Policy

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Image: Indigenous kids, publik16 / flickr

19 November 2010As the evidence mounts that efforts to ‘close the gap’ on Indigenous disadvantage are faltering, and with the recognition that much more is needed to address the health care needs across all Indigenous communities, we are confronted with a situation where 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 beginning in 1999.  It is important to note that, in comparison to 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, has been shamefully low.
 
Every year over 400,000 Indigenous Australians are entitled to receive a Medicare heath check.  In 2009-10 less than 12% 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% of children aged under 15 got a health check.

An additional issue is that there is nothing 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, but published data suggests that about 80% of health checks show health problems that need follow-up treatment or referrals.  Even in the NTER communities, with allocated funding for the purpose, the delivery of follow-up care has lagged.

The situation is aggravated because recent changes in the way Medicare Australia presents the publicly available data on the number of Indigenous health checks services delivered and their costs makes it increasingly difficult to track what is happening over time, by state, age and sex.

To address these issues and ensure that Indigenous people get access to the health care services they need, immediate action should be taken to:

1. Understand and address the barriers for GPs and their Indigenous patients to the effective and widespread utilisation of Medicare Benefits Schedule item 715.

2. Consult with Indigenous health providers and communities about the way they would prefer to see these services delivered, where and by whom.

3. Implement and fund an improved program for health assessments across all age groups.

4. Put in a place a system to ensure that all health problems found as a consequence of a health check are appropriately addressed and resolved.

5. Provide for independent and transparent monitoring and evaluation of this new program.

Image: "Aboriginal welfare quarantine 'like apartheid' ", publik16 / flickr