Access to primary health care

Primary health care is delivered in community settings, such as general practices, community health centres, Aboriginal 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.

Primary health care providers play an important role in improving health through health promotion, vaccination, health checks, screening programs, diagnosis, and treatment.

Use of Indigenous-specific primary health care services

The Australian Government provides funding to organisations to provide culturally appropriate primary health care services to Aboriginal and Torres Strait Islander people.

Indigenous-specific primary health care services are run by Aboriginal community-controlled health organisations, state/territory or local health services, or non-government organisations.

In 2017–18, most Indigenous-specific primary health care providers (95%) had a formal commitment to providing culturally safe health care, and just over half (54%) of the FTE positions in Commonwealth-funded Indigenous primary health care organisations were occupied by Indigenous Australians (AIHW 2019b).

There were 198 Indigenous-specific primary health care services in 2017–18, compared with 211 in 2008–09. Staffing levels and episodes of care generally increased in the 10 years to 2017–18, but fell between 2015–16 and 2016–17 (Figure 6.1).

Figure 6.1: Indigenous primary health care organisations, full-time equivalent staff and episodes of care, 2008–09 to 2017–18

Source: Measure 3.14, Table D3.14.47 – AIHW analysis of Service Activity Reporting and AIHW Online Services Report data collections.

Although 4 in 5 Indigenous Australians live in Major cities and regional areas where mainstream health services are typically located, these services are not always accessible, for geographic, social, and cultural reasons (AIHW 2016). So, Indigenous-specific health services are important providers of comprehensive primary health services for Indigenous Australians living in various locations.

In Very remote areas, 3 in 4 (75%) Indigenous Australians usually went to an Aboriginal Medical Service (AMS) or community clinic (in many cases that might be the only primary health care option available) (Figure 6.2).

In contrast, in Major cities, while more than 1 in 3 (35%) Indigenous Australians 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 Indigenous Australians, 2018–19

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

For further information, see:

• 3.12 Aboriginal and Torres Strait Islander people in the health workforce
• 3.14 Access to services compared with need
• 3.17 Regular general practitioner or health service

General practitioner services and health checks

Aboriginal and Torres Strait Islander people have a slightly higher rate of GP service use than non-Indigenous Australians, measured by the number of Medicare claims for GP services.

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

The first Indigenous-specific health check, for those aged 55 and over, was introduced in 1999, and health checks for Aboriginal and Torres Strait Islander people of all ages were in place from May 2006. In May 2010, the frequency of health checks was standardised so that Aboriginal and Torres Strait Islander people of all ages were able to have a health check every year (AIHW 2017).

Between 2009–10 and 2018–19, the number of Indigenous Australians accessing these health checks increased by about fivefold, 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 (2009–10 to 2017–18) and Indigenous-specific health checks (2009–10 to 2018–19)

Sources: 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.

For further information, see:

• 3.04 Early detection and early treatment
• 3.14 access to services compared with need

Immunisation

Immunisation is highly effective in reducing morbidity and mortality caused by vaccine-preventable diseases.

Based on data from the Australian Immunisation Register, between 2008 and 2018, the proportion of fully immunised Aboriginal and Torres Strait Islander children aged 5 increased from 77% to 97%. In 2018, the national rate of immunisation of Indigenous children 5 were similar to other children (97% and 95%, respectively).

Some information on vaccinations in adulthood is available from the 2018–19 National Aboriginal and Torres Strait Islander Health Survey, based on self-report. In 2018–19, an estimated 68% of Indigenous Australians aged 50 and over had been vaccinated against influenza in the previous 12 months. Between 2012–13 and 2018–19, there was an increase in the rate of vaccination against influenza among Indigenous Australians aged 50 and over, from 57% to 68%. In remote areas, the rate increased from 68% to 73% over the period, and in non-remote areas, the increase was from 54% to 67%.

In 2018–19, an estimated 32% of Indigenous Australians aged 50 and over had been vaccinated against invasive pneumococcal disease in the last five years, with similar rates in remote and non-remote areas (34% and 32% respectively).

Adult vaccinations are also targeted at younger Indigenous Australians who have various risk factors, such as chronic medical conditions. In 2018–19, 40% of Indigenous Australians aged 15–49 were vaccinated for influenza in the previous year, and 7% had received a pneumococcal vaccination in the previous five years.

For further information, see:

• 3.02 Immunisation

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, Indigenous Australians 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 have increased steadily since they were introduced in 2005 (Figure 6.4). The rate of increase has been higher among Indigenous Australians than among non-Indigenous Australians.

Figure 6.4: Chronic disease GP management plans and team care arrangements, by Indigenous status, 2009–10 to 2017–18

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

For further information, see:

• 3.05 Chronic disease management

Access to prescription medicines

Prescription medications save lives and improve quality of life. Having access to affordable medications is essential for management of both acute and chronic health conditions. Therefore, it is important to ensure that Aboriginal and Torres Strait Islander people, who experience high rates of acute and chronic illnesses, can access appropriate prescription medications.

In general, the Australian Government subsidises the cost of medicine for most medical conditions under the Pharmaceutical Benefits Scheme (PBS). In 2010, the Closing the Gap PBS Co-payment was established to reduce the cost of PBS medicines for eligible Indigenous Australians living with, or at risk of, chronic diseases (Department of Health and Aged Care 2022a).

In 2015–16, the total expenditure on pharmaceuticals in Australia for Indigenous Australians was $420 million, an average of $537 per person. For non-Indigenous Australians, the average expenditure was $891 per person.

For Indigenous Australians, the main components of Australian Government PBS expenditure were:

• mainstream PBS (61%)
• medications distributed through Aboriginal and Torres Strait Islander Health Services (Section 100 expenditure) (19%).

Between 2010–11 and 2016–17, expenditure on pharmaceuticals covered by the mainstream PBS and the Repatriation PBS grew for Indigenous Australians by 3.7% per year in real terms and by 2.8% for non-Indigenous Australians. In 2016–17, average PBS expenditure per person for Indigenous Australians was estimated to be 29% of the amount spent for non-Indigenous Australians.

In 2015–16, expenditure per Indigenous person through the mainstream PBS was highest in Remote and Very remote areas ($241) and lowest in Major cities ($116) (Figure 6.5).

Figure 6.5: Expenditure on medicines 2010–11 to 2016–17, and by remoteness area (2015–16)

Sources: Measure 3.15, Table D3.15.4 and Table D3.21.8 – AIHW Health Expenditure Database.

For further information, see:

• 3.15 Access to prescription medicines

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 2014; Levesque et al. 2013; Melbourne Vaccine Education Centre 2022).

The AIHW has modelled how Aboriginal and Torres Strait Islander people’s physical access to primary health care services (Indigenous-specific primary health care services and other GP-based primary health services) varies geographically across Australia (see also (AIHW 2014, 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:

• Indigenous-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 Indigenous-specific primary health care services appear to be well positioned relative to the geographic distribution of the Aboriginal and Torres Strait Islander population, and of other GP services. But there are several areas where the Indigenous population has potentially limited access to both Indigenous-specific services and GP services in general.

In total, 29 medium-sized areas were estimated to have at least 200 Indigenous Australians with no Indigenous-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 the number of areas in each state/territory and remoteness classification while specific areas are shown in Table 6.2. The areas are Statistical Areas Level 2 (SA2s) as described in the Australian Statistical Geography Standard (ASGS) (ABS 2016a). With populations generally ranging from 3,000 to 25,000 people, SA2s are designed to reflect communities that interact socially and economically.

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 6.1: Number of areas with potentially poor access to primary health care services, by state/territory and predominant remoteness classification^(a)(b)(c), 2018

(a) Areas correspond to the Australian Bureau of Statistics’ SA2 boundaries (see Table 6.2 for detailed list).

(b) Predominant remoteness classification based on the distribution of the Indigenous populations identified as having potentially poor access.

(c) None of the identified areas were part of Victoria or the ACT, nor were any of the areas predominantly classified as Major Cities in terms of Remoteness.

Source: AIHW analyses.

Table 6.2: SA2s with potentially poor access to primary health care services, 2018

(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 2014).

(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) Indigenous 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 Indigenous Australians 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 two 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 Indigenous-specific primary health care services (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.

Sources: AIHW analyses ; Online Services Report (2017–18).

For further information, see:

• 3.14 Access to services compared with need