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Aboriginal and Torres Strait Islander Health Performance Framework - Summary report

Access to primary health care

Primary health care is delivered in community settings, such as general practices, community health centres, First Nations health services, and allied health practices like physiotherapy. It is usually people’s first point of contact with the health system, and the gateway to specialised health services. The evidence presented in this report shows that there is a relative lack of access to PHC services in general, and particularly in remote areas where people need health care the most. Moreover, 30% of First Nations people reported that they needed health care, but had not seen a health care provider on at least once in the past 12 months.

Use of First Nations-specific primary health care services

The Australian Government provides funding to organisations to provide culturally appropriate primary health care services to First Nations people.

First Nations-specific primary health care services are run by Aboriginal Community Controlled Health Organisations (ACCHOs), state and territory, local health services, or non-government organisations.

Over the period 2006–07 to 2021–22, the number of First Nations-specific primary health care organisations increased from 147 to 211 (Figure 6.1). In 2021–22, an estimated 67% (or 142) were operated by ACCHOs. First Nations-specific primary health care organisations provided around 4.0 million episodes of care. Of these services, 84% (3.4 million) were provided to First Nations clients, and 88% (3.6 million) were provided by ACCHOs (AIHW 2023a).

Figure 6.1: Number of First Nations-specific primary health care organisations, 2006–07 to 2021–22

The line chart shows that between 2006–07 and 2021–22, the number of First Nations-specific primary health care organisations increased from 147 to 211.

Source: Measure 3.14, Table D3.14.47 – AIHW analysis of Service Activity Reporting and AIHW Online Services Report data collections for 2006–07 to 2017–18, and AIHW Online Services Report data collection for 2018–19 to 2021–22 (from: AIHW 2023a).

Although 4 in 5 First Nations people live in Major cities, inner and outer regional areas combined where mainstream health services are typically located, these services are not always accessible, for geographic, social, and cultural reasons (AIHW 2016). Further, research indicates that these services outperform mainstream services in terms of identifying and managing risks for various diseases (Panaretto et al. 2014). As such, First Nations-specific primary health services are important providers of comprehensive primary health services for First Nations people across geographic areas.

In 2018-19 in Very remote areas, 3 in 4 (75%) First Nations people usually went to an Aboriginal Medical Service (AMS) or community clinic (which may have been the only primary health care option available in many cases) (Figure 6.2).

In contrast, in Major cities, while more than 1 in 3 (35%) First Nations people would like to go to an AMS or community clinic for health problems, fewer than 1 in 6 (15%) usually went to these types of services.

Figure 6.2: Health service use and preferences among First Nations people, by remoteness, 2018–19

The first column chart shows the type of health service First Nations people usually go for addressing health problems in 2018–19. Visiting a doctor or GP is the most common choice for First Nations people residing in Major cities and Inner regional areas, whereas AMS or community clinics was the most common option for those in the other remoteness areas.The second column chart shows the type of health service First Nations they would like to go for addressing health problems. It shows that going to see doctor or GP decreases with remoteness and going to AMS or community clinic increases with remoteness. Going to hospital also increases with remoteness.

Source: Measure 3.17, Table D3.17.2 – AIHW and ABS analysis of National Aboriginal and Torres Strait Islander Health Survey 2018–19.

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General practitioner services and health checks

First Nations people have a slightly higher rate (ratio 1.1) of GP service use than non-Indigenous Australians, measured by the number of Medicare claims for GP services, but far less than the level of use required as indicated by the burden of disease (ratio 2.3).

For both First Nations people and non-Indigenous Australians, the rate of GP service use rose over the decade to 2017–18 (Figure 6.3).

In 1999, a health check especially for First Nations people aged 55 and over was introduced, and from May 2006, First Nations-specific health checks were available for people of all ages. In May 2010, the frequency of health checks was standardised so that First Nations people of all ages were able to have a health check every year (AHMAC 2017).

Between 2009–10 and 2018–19, the number of First Nations people accessing these health checks increased by about 5-fold, from 47,283 in 2009–10 to 248,841 in 2018–19. Health check rates increased across all age groups from 68 per 1,000 to 297 per 1,000 population over this period (Figure 6.3).

Figure 6.3: GP service use by Indigenous status (2009–10 to 2017–18) and First Nations-specific health checks by age group (2009–10 to 2018–19)

The first line chart shows that between 2009–10 and 2017–18, the rate of Medicare claims for GP services for First Nations people increased from 5,165 per 1,000 to 6,285 per 1,000, and the rate for non-Indigenous increased from 5,231 to 5,912 per 1,000.The second chart presents the rate of Medicare claims for health check for First Nations people from 2009-10 to 2018-19 by age group. It shows that the rate increased for all age groups, from 67 to 292 per 1,000 for ages 1-14, from 62 to 278 per 1,000 for ages 15-54, and from 113 to 396 per 1,000 for those aged 55 and over.

Source: Measure 3.04 and 3.14, Tables D3.04.5, D3.04.6, D3.04.7, D3.14.20 – AIHW analysis of Medicare Benefits Schedule data.

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Child immunisation

Immunisation is highly effective in reducing morbidity and mortality caused by vaccine-preventable diseases. According to the National Immunisation Program Schedule, Australian children are expected to have received specific immunisations by age 1, 2 and 5. First Nations people have higher rates of some vaccine preventable diseases than non-Indigenous people. For this reason, extra vaccines are available in addition to the routine vaccinations offered throughout life (pregnancy, children, adolescents, adults and seniors).

As at December 2022, based on data from the Australian Immunisation Register (AIR), the proportion of First Nations children who were fully immunised was slightly less than non-Indigenous children for those aged 1 (91% compared with 94%, respectively) and 2 (89% compared with 92%, respectively). However, for those aged 5, the proportion of First Nations children who were fully immunised was higher than that of non-Indigenous children (96% compared with 94%).

The proportion of First Nations children aged 1 and 5 who were fully immunised increased from 2013 (86% and 93%, respectively) to 2022 (91% and 96%, respectively), with no statistically significant change for First Nations children aged 2. While there was an overall improvement in immunisation coverage over the decade for First Nations children aged 1 and 5, coverage rates decreased between 2020 and 2022, coinciding with the COVID-19 pandemic. The proportion of First Nations children aged 1 who were fully immunised decreased from 94% in 2020 to 91% in 2022. For First Nations children aged 5, the proportion who were fully immunised decreased from 97% in 2020 to 96% in 2022.

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Adult immunisation

As at 31 May 2023, of the 502,765 individuals aged 18 and over within the AIR who identified as being of Aboriginal and/or Torres Strait Islander origin, 7.3% (36,631) had received a COVID-19 vaccination in the previous 6 months, 79% (395,893) had received a COVID-19 vaccination more than 6 months ago, and 14% (70,241) were unvaccinated.

Until recently, data on influenza vaccination coverage had been based on population surveys. Since 1 March 2021, there has been mandatory reporting of influenza vaccines to the AIR. Note that these data may underestimate true coverage, due to under-reporting of adult vaccinations to the AIR, and relatively recent introduction of mandatory reporting (NCIRS 2022).

In 2021, based on data from the AIR, one-quarter (25.0%) of First Nations people aged 6 months and over received an influenza vaccination. Among older First Nations adults, 43.5% of those aged 50–64, 64.6% of those aged 65–74, and 67.7% of those aged 75 and over had an influenza vaccination in 2021 (NCIRS 2022).

In 2018–19, based on survey data, an estimated 32% of First Nations people aged 50 and over had been vaccinated against invasive pneumococcal disease in the last 5 years, with similar rates in remote and non-remote areas (34% and 32%, respectively).

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Chronic disease management

Good quality health care for people with chronic disease often involves multiple providers across multiple settings. The Chronic Disease Management GP services on the Medicare Benefits Schedule enable GPs to coordinate the health care of patients with chronic or terminal medical conditions, including patients who require multidisciplinary, team-based care from multiple providers. The Chronic Disease Management services include general practitioner management plans (GPMPs) and team care arrangements (TCAs).

In general, First Nations people have higher rates of chronic disease than non-Indigenous Australians, and hence, have a higher need for Chronic Disease Management services. Rates of Medicare claims for GPMPs and TCAs increased steadily from 2009–10 to 2017–2018 (Figure 6.4). The rate of increase has been higher among First Nations people than among non-Indigenous Australians (annual increase in the age-standardised rate of GPMPs and TCAs were 8.5 and 8.2 per 1,000 for First Nations people, compared with 6.5 and 5.7 per 1,000 for non-Indigenous Australians, respectively).

Figure 6.4: Age-standardised rate of chronic disease GP management plans and team care arrangements, by Indigenous status, 2009–10 to 2017–18

The first chart shows that the rate of chronic disease GP management plans First Nations people increased from 69 per 1,000 in 2009-10 to 142 per 1,000 in 2017-18, and the rate for non-Indigenous Australians increased from 48 to 100 per 1,000.The second chart shows that the rate of chronic disease team care arrangements for First Nations people increased from 55 to 125 per 1,000, and for non-Indigenous Australians from 38 to 85 per 1,000.

Source: Measure 3.05, Table D3.05.1 – AIHW analysis of Department of Health Medicare claims data.

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Access to primary health services in different areas

Measuring access to health services is complex. ‘Access’ can include:

  • physical access (whether health services with sufficient capacity are located within a certain distance or drive time from where a person lives)
  • approachability (awareness of a service and how it impacts health outcomes)
  • appropriateness (fit between services and client needs)
  • affordability
  • cultural acceptability (AIHW 2014b; Levesque et al. 2013; Melbourne Vaccine Education Centre 2022).

The AIHW has modelled how First Nations people’s physical access to primary health care services (First Nations-specific primary health care services and other GP-based primary health services) varies geographically across Australia (see also AIHW 2014a, 2015b). This modelling can be used to identify areas where access to primary health care services appears to be relatively poor.

Physical access to services was modelled with reference to:

  • First Nations-specific primary health care services, based on drive time to services.
  • GP services in general, based on drive time to services, the capacity of GP services, the size of local populations, and their per person need for primary health care.

The need for primary health care was estimated using demographic and socioeconomic characteristics of the local population.

This work shows that, overall, Australian Government-funded First Nations-specific primary health care services appear to be well positioned relative to the geographic distribution of the First Nations population, and of other GP services. However, there are several areas where First Nations people have potentially limited access to both First Nations-specific services and GP services in general.

In total, 29 medium-sized areas were estimated to have at least 200 First Nations people with no First Nations-specific primary health care services within one hour’s drive and relatively poor access to GP services based on drive times and local population needs. Table 6.1 shows specific areas with potentially poor access to primary health care services in each state and territory and remoteness classification. The areas are Statistical Areas Level 2 (SA2s) as described in the Australian Statistical Geography Standard (ASGS) (AIHW 2016). populations generally ranging from 3,000 to 25,000 people, SA2s are designed to reflect communities that interact socially and economically. The numbers of areas are presented in Table 6.2.

Table 6.1: SA2s with potentially poor access to primary health care services, 2018

State/territory

SA2 name (code)

Estimated First Nations population with low access to GPs and no ISPHCS within 1 hour’s drive(a)(b)(c)(d)

NSW

Young (101061543)

555

NSW

Lithgow Region (103031071)

285

NSW

Narrabri (110031197)

270

NSW

Mudgee Region – West (103031074)

260

NSW

Bourke – Brewarrina (105011092)

250

NSW

Young Region (101061544)

215

NSW

Mudgee Region – East (103031073)

210

NSW

Scone Region (106041129)

210

Qld

Central Highlands – East (308011190)

670

Qld

Broadsound – Nebo (312011338)

360

Qld

Gympie Region (319031514)

295

Qld

Barcaldine – Blackall (315031408)

290

Qld

Cape York (315011396)

275

Qld

Cooloola (319031511)

275

Qld

Mount Isa Region (315021406)

205

Qld

Collinsville (312011340)

205

WA

Ashburton (510031271)

820

WA

Derby – West Kimberley (510011263)

755

WA

East Pilbara (510021267)

560

WA

Brookton (509031246)

405

WA

Cunderdin (509021237)

325

WA

Kununurra (510011265)

320

WA

Exmouth (511021277)

250

WA

Halls Creek (510011264)

250

SA

Outback (406021141)

255

Tas

North West (604031094)

355

NT

West Arnhem (702031061)

670

NT

Sandover – Plenty (702011052)

410

NT

Thamarrurr (702031059)

225

(a)    With regards to this analysis, low access to GPs was defined by an AIHW Access score of less than 7 (for comparison, the average Access score measured for Sydney’s residents was ~10.5). This analysis is part of a forthcoming AIHW publication. Previous analysis related to this can be found in the ‘Access to primary health care relative to need for Indigenous Australians’ report (AIHW 2014a).
(b)    Indigenous-specific primary health care services (ISPHCSs) included in this analysis correspond to clinical services funded by the Department of Health’s Indigenous Australians’ Health Programme that reported a GP workforce in the 2017–18 Online Services Report.
(c)    First Nations populations were estimated for small geographic areas (SA1) by the AIHW for years 2016 to 2018 using Iterative Proportional Fitting with available ABS data. The analysis in this table refers to 2018 population estimates (rounded to the nearest 5 persons).
(d)    The results shown include only SA2s where a sum of at least 200 First Nations people live in SA1s with access scores below 7 and who seem to live further than 1 hour’s drive from an ISPHCS clinic, based on simplified representation of peoples’ usual addresses, and drive-times calculated with Pitney Bowes’ MapInfo RouteFinder software.
Notes
1.    These areas have been identified based on supporting analysis, which may be subject to small changes.
2.    Areas are identified by 2 mechanisms. 1. The AIHW’s access scores, which are derived from several estimated data inputs, including GP capacities, population sizes, population distribution, per capita need, drive-times, as well as modelling parameters. Uncertainties in all of these inputs affect the quality of the results. 2.    The location of ISPHCSs. Due to data gaps, some relevant service locations may not have been included and other service locations may have been included that do not offer clinical services.
3.     A small number of areas were removed from the list due to known data issues or the opening of new ISPHCS clinics.
4.     NSW: New South Wales, Qld: Queensland, WA: Western Australia, SA: South Australia, Tas: Tasmania, NT: Northern Territory.
Source: AIHW analyses; Online Services Report (2017–18).

Across Australia, the number of areas with potentially poor access to primary health care services are almost same for regional (Inner and outer regional areas combined) and remote (Remote and very remote areas combined) areas (Table 6.2). Identifying areas based on the number of people in them with poor access rather than on average access for the whole area is a different approach to earlier reports (AIHW 2015b) and gives somewhat different results. This approach ensures that areas that have relatively good average access but also have substantial numbers of people with poor access are not overlooked.

Table 6.2: Number of areas with potentially poor access to primary health care services, by state and territory and predominant remoteness classification, 2018

Number of areas by predominant remoteness classification(a)(b)(c)

State and territory

Inner and outer regional

Remote and very remote

Total

New South Wales

7

1

8

Queensland

4

4

8

Western Australia

2

6

8

South Australia

1

1

Tasmania

1

1

Northern Territory

3

3

Australia

14

15

29

(a)    Areas correspond to the Australian Bureau of Statistics’ SA2 boundaries (see Table 6.1 for detailed list).
(b)    Predominant remoteness classification based on the distribution of the First Nations populations identified as having potentially poor access.
(c)    None of the identified areas were part of Victoria or the Australian Capital Territory, nor were any of the areas predominantly classified as Major cities in terms of Remoteness.
Source: AIHW analyses; Online Services Report (2017–18).

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