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Tier 3 - Health system performance

3.14 Access to services compared with need

Key facts

Why is it important?

Defining and measuring access to health care is complex as it encapsulates not only the availability and supply of services but also financial, organisational, social and cultural barriers that limit the use of services (Gulliford et al. 2002). Levesque and others (2013) in conceptualising ‘access’ identified not only the characteristics of services that facilitate access (approachable, acceptable, available, affordable and appropriate) but also explored individual’s abilities to engage with services such as the ability to perceive, seek, reach, pay and engage with services (Levesque et al. 2013).

While the causes of illness and injury for any community operate within broad environmental, social and personal factors, the health system has an important role in assisting with prevention through population health programs (see measure 3.03 Health promotion); providing an immediate response to acute illness and injury (see measure 1.02 Top reasons for hospitalisation); and protect good health through screening, early intervention and treatment (see measures 3.04 Early detection and early treatment and 3.05 Chronic disease management) (Dwyer et al. 2004). However, for Aboriginal and Torres Strait Islander people, inequalities in access to services mean that the benefits of health care advances have not been shared equally. Indigenous Australians face barriers that other groups do not.

Indigenous Australians experience significantly poorer health outcomes than non-Indigenous Australians. Inequalities in health care access and use are considered important drivers of this difference (OECD 2009). Therefore, access to health care commensurate with the level of need is therefore essential to closing the gap in life expectancy between Indigenous and non-Indigenous Australians.

Findings

What does the data tell us?

Self-reported use of services

According to the 2018–19 National Aboriginal and Torres Strait Islander Health Survey (Health Survey), 45% (368,000) of Indigenous Australians reported that they had accessed health-care in the previous two weeks. In these two weeks, 23% (186,400) of Indigenous Australians had consulted a doctor or specialist, 22% (181,700) had consulted other health professionals, 7% (55,100) had visited casualty/outpatient services and 5% (38,000) had seen a dentist. In the previous 12 months, 17% (138,800) had been admitted to hospital (Table D3.14.1). Of Indigenous Australians aged 15 and over, 86% (461,700) had consulted a general practitioner (GP) or specialist in the last 12 months (Table D3.03.3).

Indigenous Australians were more likely to have visited a doctor in the last 12 months if they had the following conditions (compared with those without the conditions): a disability (1.7 times), three or more long-term health conditions (3.2 times) and/or high/very high psychological distress (1.4 times) (Table D3.14.10).

Services claimed through Medicare

In 2017–18, over 9.5 million Medicare claims were made for services provided to Indigenous Australians, of which 4.6 million were for GP services (note: not all care delivered through Indigenous primary health-care services can be claimed through Medicare) (Table D3.14.23).

Indigenous females claimed Medicare services at 1.6 times the rate as of Indigenous males (18,460 and 11,826 per 1,000, respectively). Non-Indigenous females claimed Medicare services at 1.4 times the rate of non-Indigenous males (Table D3.14.42).

Between 2003–04 and 2017–18, the rate of GP Medicare items claimed for Indigenous Australians increased by 42% and has been slightly higher than the rate for non-Indigenous Australians since 2010–11 (Table D3.14.20, Figure 3.14.1).

The rate of Medicare claims for health assessment items for Indigenous Australians increased since 2009–10, as have claims for team care arrangements (TCA) and GP management plans (GPMP) services (Table D3.04.3, Table D3.05.1). In 2017–18, the rate for these chronic disease management items (GPMPs and TCAs combined) for Indigenous Australians was 1.4 times as high as non-Indigenous Australians (267 per 1,000 compared with 185 per 1,000) (Table D3.14.23).

Figure 3.14.1: Age-standardised rates of GP MBS services claimed through Medicare, by Indigenous status, 2003–04 to 2017–18

This line chart shows that while the rate has increased for both Indigenous and non-Indigenous Australians over the period, the increase for Indigenous Australians was larger and overtook the non-Indigenous rate in 2010–11. The Indigenous rate increased from 4,648 to 6,285 per 1,000, while the non-Indigenous rate increased from 4,772 to 5,912 per 1,000.

Source: Table: D3.14.20. AIHW analysis of Medicare Data.

While the burden of disease and mortality rate of Indigenous Australians are more than double those of non-Indigenous Australians, Indigenous Australians use GP services at a rate that is only slightly higher to that of non-Indigenous Australians. In 2017–18, Indigenous Australians’ rate of GP service use—as indicated by Medicare claims for GP items—was 1.2 times that of non-Indigenous Australians (Table D3.14.23).

The difference between the mortality rates of Indigenous and non-Indigenous Australians (expressed as a ratio) was noticeably higher between ages 25–64 (Table D1.22.2, Figure 3.14.2). However, Indigenous Australians’ rate of GP service use compared with non-Indigenous Australians’ rate of use (expressed as a ratio) did not differ greatly across age groups. This should be interpreted with caution as the underlying number of deaths is small (Table D3.14.26, Figure 3.14.2).

Figure 3.14.2: Comparing mortality rate ratios (2014–2018) with accessing MBS GP services rate ratio (2017–18), by age group

These two line charts show the age-specific rate ratios (Indigenous rate divided by non-Indigenous rate) for mortality and MBS GP service claims, respectively. The first chart shows that the mortality rate ratio increased from around 2 for those aged 0–4 to around 3.5 for those aged 35–44, and then decreased to around 1 for those aged 75+. The second chart shows that the GP claim rate ratio increased from 1.0 for those aged 0–4 to 1.4 for those aged 55–59, before decreasing to 0.9 for those aged 65+.

Source: Table D1.22.2, AIHW and ABS analysis of the ABS Causes of Death Collection. Table D3.14.26, AIHW analysis of Medicare Data.

For GP services, Indigenous Australians claimed at lower a rate as remoteness increased, reflecting that many Indigenous Australians live in areas with a challenging access situation (AIHW 2014, 2015) (Table D3.14.37, Figure 3.14.3).

Figure 3.14.3: Age-standardised rate of GP MBS services claimed through Medicare, by Indigenous status and remoteness, 2017–18

This bar chart shows that while the rate of GP MBS claims decreased as the remoteness level increased for Indigenous and non-Indigenous Australians, the rate was higher for Indigenous Australians in all areas. The rate for Indigenous Australians ranged from 8,033 per 1,000 in Major cities to 4,991 per 1,000 in Very remote areas.

Source: Table D3.14.37. AIHW analysis of Medicare Data.

Medicare item claims for specialist and psychologist items were lower for Indigenous than non-Indigenous Australians. There was a clear gradient, reducing by remoteness, in the rate of Medicare service claims for GP, allied health and specialist services for both Indigenous and non-Indigenous Australians. Against this gradient, the rate of claims for nurse/Aboriginal health worker services increased by remoteness for Indigenous Australians. This also reflects types of services available in Remote areas.

The Medicare claim rate for specialist care among Indigenous Australians was the highest in Major cities (860 per 1,000) and lowest in Very remote areas (161 per 1,000), and rate was between 24%–70% lower than for non-Indigenous Australians in all remoteness areas (Table D3.14.37, Figure 3.14.4).

Figure 3.14.4: Age-standardised rate of specialist MBS services claimed through Medicare, by Indigenous status and remoteness, 2017–18

This bar chart shows that while the rate of specialist claims decreased as the remoteness level increased for Indigenous and non-Indigenous Australians, the rate was higher for non-Indigenous Australians in all areas. The rate for Indigenous Australians ranged from 860 per 1,000 in Major cities to 161 per 1,000 in Very remote areas.

Source: Table D3.14.37. AIHW analysis of Medicare Data.

In 2017–18, the most common Medicare items claimed by Indigenous Australians were for standard GP consultations (2.5 million) and pathology services (3.2 million). Out-of-pocket costs for services claimed through Medicare were lower for Indigenous Australians (8% of fees claimed) than non-Indigenous Australians (23% of fees claimed).

For Indigenous Australians, out-of-pocket costs were minimal (0% or under 0.1%) for Aboriginal Health Worker items, Indigenous health checks, TCAs and GPMPs and higher for specialists (24%), diagnostics (10%), allied health (10%) and imaging (6%) (Table D3.14.23). 

Indigenous primary health-care organisations

There has been an overall increase in the number of Commonwealth-funded Indigenous primary health-care organisations, from 108 in 1999–2000 to 198 in 2017–18.

Over this period, episodes of health care for clients of these organisations have increased from 1.2 million to 3.6 million, and full‑time equivalent (FTE) staff (both paid by the service and visiting) more than tripled from 2,300 to 8,215 (Table D3.14.47, Figure 3.14.5).

Figure 3.14.5: Cumulative per cent changes to Indigenous primary healthcare organisations, 1999–2000 to 2017–18

This line chart shows that from 1999–00 to 2017–18 there has been a 257% increase in the number of full time equivalent staff, and a 195% increase in the number of episodes of care. The increase in staff has been relatively consistent, while the cumulative increase for episodes of care peaked at 217% in 2015–16, before dropping to 164% in 2016–17.

Source: Table D3.14.47. AIHW analysis of Service Activity Reporting and AIHW Online Services Report data collections.

Commonwealth-funded Indigenous primary health-care organisations were asked to select the top five service gaps faced by their patients. Access to services was reported as a top five health service gap by 33% of organisations (Table D3.14.53). The proportion of organisations reporting ‘access to services’ as a top five health service gap varied by jurisdiction from 21% in Queensland to 57% in Tasmania (Table D3.14.54).

The main service gaps reported by Indigenous primary health-care organisations included mental health/social and emotional health and wellbeing (68%), youth services (54%) and alcohol, tobacco and other drug services (45%) (Table D3.14.55). Health service challenges reported by these organisations included recruitment, training and support of Indigenous staff (71%), staffing levels (63%) and staff retention/turnover (54%) (Table D3.14.56).

Hospital care

Between July 2015 and June 2017, there were 542,917 hospitalisations (excluding dialysis) for Indigenous Australians. After adjusting for differences in the age structure between the two populations, Indigenous Australians were hospitalised at 1.2 times the rate of non-Indigenous Australians (436 and 352 per 1,000, respectively). Hospitalisations for Indigenous Australians varied from 373 per 1,000 in Major cities to 599 per 1,000 in Remote areas (see measure 1.02 Top reasons for hospitalisation) (Table D1.02.3, Figure 3.14.6).

Figure 3.14.6: Age-standardised hospitalisation rates (excluding dialysis), by Indigenous status and remoteness, July 2015 to June 2017

This bar chart shows that while the hospitalisation rate for Indigenous Australians was higher for those in Remote, Very remote and Outer regional areas than for those in Major cities and Inner regional areas, the rate for non-Indigenous Australians the rate was consistent across all areas of remoteness. The greatest difference was in Remote areas, 599 and 340 per 1,000 for Indigenous and non-Indigenous Australians, respectively, while in Major cities the difference was the lowest, 373 and 349 per 1,000, respectively.

Source: Table D1.02.3. AIHW analysis of National Hospital Morbidity Database.

Elective surgery

Between July 2015 and June 2017, the overall rate of elective surgery for Indigenous Australians was lower compared with non-Indigenous Australians (56 and 84 per 1,000, respectively) (Table D3.14.52). In this period, there were 51,064 hospitalisations from public hospital elective surgery waiting lists for Indigenous Australians (excluding the Australian Capital Territory), representing 4% of hospital admissions from waiting lists for elective surgery (Table D3.14.51).

The median public hospital waiting time for elective surgery was higher for Indigenous Australians compared with non-Indigenous Australians (44 and 37 days, respectively). For Indigenous Australians, the median wait time was highest for septoplasty (procedure of the septum—287 days) and total knee replacement (255 days) (Table D3.14.53).

Emergency care

Between July 2015 and June 2017, around 6% (almost 864,000) of emergency department presentations reported were for Indigenous Australians (excluding the Australian Capital Territory) (Table D3.14.50).

In 2017–18, the median waiting time for Indigenous Australians was the same as for non-Indigenous Australians (both 19 minutes). The proportion of Indigenous Australian presentations seen on time was similar to that for Other Australians (73% and 72% respectively) (AIHW 2018).

Between July 2015 and June 2017, across triage categories 99.8% of Indigenous Australians were seen on time for triage category 1 (resuscitation), 77% for category 2 (emergency), 68% for urgent and 75% for semi-urgent. For non-urgent patients, 93% were seen on time (within 2 hours) (Table D3.14.50).

The total number of emergency hospitalisations was higher for Indigenous Australians compared with non-Indigenous Australians (23 and 13 per 1,000, respectively) (Table D3.14.52).

The average length of stay for overnight acute hospitalisations was lower for Indigenous Australians compared with non-Indigenous Australians (3.9 and 4.2 days, respectively) (Table D3.14.54).

The Royal Flying Doctor Service (RFDS) provides emergency and other healthcare for those living in Remote and Very remote areas. Between July 2013 and December 2015, the RFDS conducted 17,606 aeromedical retrievals for Indigenous Australians (over one-quarter of all retrievals) (Bishop et al. 2016).

Palliative care

Between July 2015 and June 2017, after adjusting for differences in the age structure between the two populations, Indigenous Australians were hospitalised for palliative care at 1.7 times the rate as non-Indigenous Australians (2.6 and 1.5 per 1,000, respectively). Indigenous patients accounted for 2.2% (1,845) of all hospitalisations for palliative care (Table D3.14.48).

Hospitalisation for palliative care for Indigenous Australians ranged from a low of 2.3 per 1,000 in Major cities areas, to a high of 3.6 in Remote areas (Table D3.14.49).

In 2017–18, palliative care was a health service gap for 15% of Commonwealth-funded Indigenous primary health-care organisations (Table D3.14.55).

Self-reported barriers

In the 2018–19 Health Survey, 30% (243,660) of Indigenous Australians reported that they needed to, but did not see a health care provider in the previous 12 months. This varied by the type of service, 19% (146,680) did not go to a dentist, 13% (102,030) a doctor, 10% (46,180) a counsellor, 9% (73,040) other health professional, and 6% (50,650) did not go to a hospital when needed.

Indigenous Australians living in Non-remote areas (32%) were more likely to report not seeking care when needed than those living in Remote areas (23%). The reasons for not seeking various health-care when needed varied by type of service. Cost was the main reason for not seeking care for some services (dentist, other health provider), for others waiting time was a more important barrier (doctor, hospital).

Reasons for not going to a doctor when needed included (more than one response was allowed): being too busy (33%); decided not to seek care (28%); waiting time too long/service not available at the time required (16%); transport/distance (14%); dislikes service/professional or is embarrassed/afraid (11%); felt service would be inadequate (10%); cost of service (7%); does not trust service provider (4%); service not available in area (2%); and discrimination/not culturally appropriate/language problem (1%). Cost was a major barrier to accessing dentists (42% overall and 32% in relation to children) (Table D3.14.14).

Private health insurance

In 2018–19, in Non-remote areas, 21% of Indigenous Australians aged 15 and over were covered by private health insurance (similar to 20% in 2012–13). The rate of private health insurance cover was similar for Indigenous males (20%) and females (21%) (Table D3.14.17). From July 2013 to June 2015, 6% of procedures recorded for Indigenous Australians occurred in private hospitals, compared with 36% for non-Indigenous Australians (Table D3.06.6).

Service/provider availability

In 2015, the full-time equivalent (FTE) rates for medical practitioners working as clinicians varied from 442 per 100,000 in Major cities to 263 per 100,000 in Remote/Very remote areas. This reflects the pattern for specialists; for GPs, the FTE rate was highest in Remote/Very remote areas (136 per 100,000) compared with Major cities (112 per 100,000) (AIHW 2016a). For nurses, the FTE rate ranged from 1,083 in Outer regional areas to 1,219 in Remote areas (AIHW 2016b).

Analysis of the distribution of the clinical health workforce in relation to the Indigenous Australian population found that a higher proportion of Indigenous Australians live in areas with lower health workforce access scores (based on the Geographically-adjusted Index of Relative Supply) than non-Indigenous Australians. This index is used to look at the geographic supply of the clinical health workforce in seven key professions with particular relevance to Indigenous Australians, and to identify areas in Australia that face particular supply challenges. It was estimated that approximately 46,200 Indigenous Australians live in areas of low relative supply of GPs (6.9% of the Indigenous population compared with 0.5% of the non-Indigenous population) (AIHW 2016c).

Patient experience

Accessing the health system can be affected by patient experience. In the 2018–19 Health Survey, 23% (116,200) of Indigenous Australians aged 15 and over reported they had been treated unfairly in the previous 12 months because they are Indigenous. Around 14% (69,700) of Indigenous Australians reported that they avoided situations due to past unfair treatment. Of those, 13% (8,900) had avoided seeking care from doctors, nurses or other staff at hospitals or doctor’s surgeries because of previous unfair treatment (Table D3.08.17).

Indigenous Australians aged 15 and over in Non-remote areas reported their GP or specialist in the previous 12 months always or often: showed them respect (91%; 312,690), listened carefully to them (89%; 305,240), and spent enough time with them (88%; 300,760) (Table D3.08.21).

What do research and evaluations tell us?

Gulliford and others (2002) and Ware (2013) outlined the following requirements for health care access:

  • availability of adequate services
  • addressing factors that may act as barriers to accessibility of health services, such as affordability and geographic accessibility
  • effective health services that deliver acceptable health outcomes
  • services that are appropriate to varying health needs and cultural settings (Gulliford et al. 2002; Ware 2013).

A review by Levesque and others (2013) built on this accessibility frame to include the ability or power of the population to utilise services, including the ability to perceive health care needs, seek, reach, pay and engage in order to obtain health care (Levesque et al. 2013).

The availability of health services relates to the location of facilities and timely provision of professional services. The 2006 Community Housing and Infrastructure Needs Survey (CHINS) reported that among 1,187 discrete Indigenous communities, 71% were at least 100 kilometres from the nearest hospital, 44% were at least 100 kilometres from the nearest Aboriginal Primary Health Care Centre and only around 10% of communities had an Aboriginal Primary Health Care Centre located within the community. Around two-thirds of communities could access an Indigenous health worker daily and around half had daily access to a registered nurse. Less than 10% of these communities could access a doctor on a daily basis (ABS 2006). Francis and others (2020) reviewed the availability of inpatient hospital services in 533 smaller Australian towns (population 1,000 to 4,999), and found 14 towns with a population for which more than 80% were Indigenous Australian. These 14 towns were less likely than other towns to either have a hospital or be within 50 kilometres of one (Francis et al. 2020).

The Australian Institute of Health and Welfare explored access to health services relative to need in 2014 and found health outcomes improved with better access to GPs in areas with relatively high predicted need for primary health care than in areas with low predicted need. Indigenous Australians experience a general pattern of worsening access to GPs relative to need with increasing remoteness, and this pattern is less strong for non-Indigenous Australians (AIHW 2014). McGrail and Humphreys (2015) studied spatial disparities of access to primary health care across rural Australia and also found that more remote areas experienced poorer access than more populated rural areas. However, they also found numerous rural areas close to cities with very poor access (McGrail & Humphreys 2015).

Issues relating to the accessibility of health services go beyond the physical distance to include transport disadvantage, or ongoing difficulties associated with access to transport (Rosier 2011) and relates to the use of both public and private transport. Currie (2009) noted that the low density of Australian cities and associated travel distances make private car ownership a logical requisite for work, leisure and service access. However, people on lower incomes face more prohibitive purchase and maintenance costs, resulting in less equity of access to private car access (Currie 2009). Outer-urban or “fringe” areas tend to have greater transport disadvantage than inner urban areas. Rosier and McDonald (2011) noted that transport disadvantage is more pronounced in those outer-urban areas with poor public transport, low-incomes and long distances for work and service access (Rosier 2011). Madill and others (2018) also found substantially higher travel times to diabetic health services for people living in outer-urban areas of Melbourne compared with those living in established areas (Madill et al. 2018). Transport disadvantage is also experienced more by specific groups including people with a disability or low incomes, and Indigenous Australians in Remote areas with limited access to both public transport and private cars (Rosier 2011).

The affordability of health care includes financial expenses for health services, pharmaceuticals, accommodation, rehabilitation and travel. These also incur a time-cost and this is associated with disruption to community or family. The lower than average incomes of Indigenous Australians limits the ability to contribute to the financial costs of health care through private expenditure and this limits the accessibility of health care. Tynan and others (2020) found in a rural Indigenous Australian community that Indigenous Australians have a higher rate of oral disease and a lower rate of accessing dental health services than non-Indigenous Australians. They found that lower use of dental care was due to difficulties in accessing care and cost. However, importantly, oral health remained a priority for members of the community (Tynan et al. 2020).

The appropriateness of health services affects the uptake of care by Indigenous Australians. Cultural security is an essential requirement of health services without which Indigenous Australians can suffer emotional and physical discomfort, which then leads to insufficient use of health services and poorer health outcomes (Coffin 2007). Cultural security is essential to all aspects of the health system and health providers should develop an understanding of cultural security. This should be applied to Indigenous patients from the start of health care provision. Yashadhana and others (2020) interviewed adults with diabetes in four remote Indigenous communities and found limited access to health information and interpreters, language barriers, distrust of health providers and limited cultural responsiveness among non-Indigenous clinicians. The study recommends increased access to Indigenous language interpreters and cultural brokers, understandable and culturally sensitive diabetic eye health information and cultural responsivity training for non-Indigenous health care providers (Yashadhana et al. 2020).

Research from India, has shown that the availability and affordability of services are not enough to achieve engagement with marginalised or culturally diverse groups such as local indigenous people. The study found that although services were clinically sound and subsidised, they did not acknowledge the cultural and traditional values of the community they were serving and this led to resistance from the community (George et al. 2020). Although this was a study in a different cultural setting it highlights the generalisable importance of getting the basics right for culturally safe service delivery in order to build trust and engagement from the client population.

In 2017 the Australian Government Department of Health undertook two overarching evaluations of the Indigenous Australians’ Health Programme (IAHP) to assess the appropriateness and effectiveness of primary health care for Indigenous Australians and to inform implementation and refinement of the IAHP. The first is an evaluation of the Australian Government’s investment in Aboriginal and Torres Strait Islander Primary Health Care and has two phases. Phase one, Evaluation Co-design, was completed in mid–2018 with the development of a Monitoring and Evaluation Design Report (DoH 2018a). Phase two, Evaluation Implementation, commenced in November 2018 and is being undertaken over four years.

The second is an economic evaluation with two phases. Phase One focused on the return on investment of the IAHP and was completed in mid–2018 (DoH 2018b). The Phase One Report showed:

  • Research literature provided evidence of a strong correlation between Aboriginal Community Controlled Health Services (ACCHS) episodes of care and prevented hospitalisations.
  • The analysis of national data for this project found a preventative effect upon hospitalisations from ACCHS care.
  • Provision of care through mainstream services is associated with worse health outcomes for Indigenous Australians because mainstream services provide a less comprehensive and less integrated approach.
  • Indigenous Australians may face financial difficulties in accessing mainstream services, and if reliance were to be placed on mainstream services in lieu of ACCHSs, reduced attendance and adherence to treatment is highly likely due to services that may not meet their cultural needs and expectations.

Phase two will evaluate the return on investment of the IAHP more broadly, starting with identifying and addressing data development needs for a robust economic evaluation. This will be undertaken as part of a broader evaluation of Indigenous primary health care.

Implications

The analysis has shown an increase in health assessments, GPMPs and TCAs claimed through Medicare since the implementation of enhanced Indigenous chronic disease initiatives in 2009. There have also been general increases in episodes of care provided through Indigenous primary health care services (with some exceptions). These improvements, while encouraging, have not yet dramatically reduced the gap in mortality rates between Indigenous and non-Indigenous Australians. Indigenous Australians currently experience significantly poorer health, a rate of access to health services 2–3 times the non-Indigenous rate should be expected in order to meet the need for health care but this is not the case. This is illustrated by three stark contrasts in the data:

  • The rate of Medicare claims for chronic disease management items for Indigenous Australians is only 1.4 times as high as non-Indigenous Australians despite mortality rate ratios being higher.
  • The age-specific gap (relative to non-Indigenous Australians) in mortality rate is higher than the age specific gap in Medicare claims for GP service use.
  • The gradient by remoteness for Medicare claims for specialists is present for both Indigenous and non-Indigenous Australians, but there is also a widening of the gap, which suggests the barriers to accessing specialist health care for Indigenous Australians in Remote and Very remote areas have a greater effect than those faced by non-Indigenous Australians in those areas.

These contrasts are crude measures but point to a continued underutilisation of appropriate and timely health care by Indigenous Australians compared with their level of need. Lessons to be gained from the evaluation of the Indigenous Australians’ Health Programme will be particularly important in the coming years in identifying service gaps.

The data also show that Indigenous Australians have lower levels of private health insurance, are more likely to use public hospital services and have lower rates of elective and preventative surgery. This suggests that a range of factors relating to the accessibility, affordability and appropriateness of health care need greater attention.

There is a need to address recruitment and retention of staff in rural and Remote areas (see measure 3.22 Recruitment and retention of staff), ensure the cultural competency of services (see measure 3.08 Cultural competency), and consider service delivery options to overcome distance, cost and complicated referral processes. Having Indigenous Australians employed within health care services has been identified as an enabler to developing relationships with patients and promoting access (Askew et al. 2014) (see measure 3.12 Aboriginal and Torres Strait Islander people in the health workforce).

The policy context is at Policies and strategies.

References

  • ABS (Australian Bureau of Statistics) 2006. 4710.0 - Housing and Infrastructure in Aboriginal and Torres Strait Islander Communities, Australia, 2006.  (ed., Australian Bureau of Statistics). Canberra.
  • AIHW (Australian Institute of Health and Welfare) 2014. Access to primary health care relative to need for Indigenous Australians. Cat. no. IHW 128. Canberra: AIHW.
  • AIHW 2015. Spatial variation in Aboriginal and Torres Strait Islander people’s access to primary health care. Cat. no. IHW 155. Canberra: AIHW.
  • AIHW 2016a. Medical practitioners workforce 2015. Cat. no. WEB 140. Canberra: AIHW.
  • AIHW 2016b. Nursing and midwifery workforce 2015. Cat. no. WEB 141. Canberra: AIHW.
  • AIHW 2016c. Spatial distribution of the supply of the clinical health workforce 2014: relationship to the distribution of the Indigenous population. Cat. no. IHW 170. Canberra: AIHW.
  • AIHW 2018. Emergency department care 2017–18: Australian hospital statistics. Health services series no. 89. Cat. no. HSE 216. Canberra: AIHW.
  • Askew D, Brady J, Brown A, Cass A, Davy C, DeVries J et al. 2014. To your door: Factors that influence Aboriginal and Torres Strait Islander peoples seeking care. Sydney: KVC.
  • Bishop L, Laverty M & Gale L 2016. Providing aeromedical care to remote Indigenous communities. Canberra: Royal Flying Doctor Service
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  • Currie G 2009. Australian Urban Transport and Social Disadvantage. Australian Economic Review 42:201-8.
  • DoH (Australian Government Department of Health) 2018a. Evaluation of the Australian Government’s Investment Aboriginal and Torres Strait Islander Primary Health Care through the Indigenous Australians’ Health Programme, Monitoring and Evaluation Design Report.
  • DoH 2018b. Economic Evaluation of the Indigenous Australians’ Health Programme Phase 1 Report.
  • Dwyer J, Silburn K & WIlson G 2004. National Strategies for Improving Indigenous Health and Health Care. Vol. Volume 1 (ed., Office for Aboriginal and Torres Strait Islander Health). Canberra: OATSIH.
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  • George MS, Davey R, Mohanty I & Upton P 2020. “Everything is provided free, but they are still hesitant to access healthcare services”: why does the indigenous community in Attapadi, Kerala continue to experience poor access to healthcare? International Journal for Equity in Health 19:105.
  • Gulliford M, Figueroa J, Morgan M, Hughes D, Gibson B, Beech R et al. 2002. What does 'access to health care' mean? Journal of health services research & policy 7:186-8.
  • Levesque J-F, Harris MF & Russell G 2013. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. International Journal for Equity in Health 12:18.
  • Madill R, Badland H, Mavoa S & Giles-Corti B 2018. Comparing private and public transport access to diabetic health services across inner, middle, and outer suburbs of Melbourne, Australia. BMC health services research 18:286.
  • McGrail MR & Humphreys JS 2015. Spatial access disparities to primary health care in rural and remote Australia. Geospat Health 10:358.
  • OECD (Organisation for Economic Co-operation and Development) 2009. Measuring disparities in health status and in access and use of health care in OECD countries. OECD Publishing.
  • Rosier KaM, M 2011. The relationship between transport and disadvantage in Australia. Australian Institute of Family Studies.
  • Tynan A, Walker D, Tucker T, Fisher B & Fisher T 2020. Factors influencing the perceived importance of oral health within a rural Aboriginal and Torres Strait Islander community in Australia. BMC Public Health 20:514.
  • Ware VA 2013. Improving the accessibility of health services in urban and regional settings for Indigenous people.  (ed., Australian Institute of Health and Welfare & Australian Institute of Family Studies). Canberra: Closing the Gap Clearinghouse.
  • Yashadhana A, Fields T, Blitner G, Stanley R & Zwi AB 2020. Trust, culture and communication: determinants of eye health and care among Indigenous people with diabetes in Australia. BMJ Global Health 5:e001999.

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