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. There is evidence presented in this report showing that there is a relative lack of access to PHC services in remote areas where health care needs are highest. In addition, 30% of the Indigenous population who reported that they needed to, but did not see a health care provider on at least one occasion in the previous 12 months.

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 (ACCHOs), state/territory or local health services, or non-government organisations.

In 2021–22, there were 211 Commonwealth-funded Indigenous primary health care organisations providing services. An estimated 67% (or 142) were operated by ACCHOs. In 2021–22, organisations provided around 4.0 million episodes of care. Of these services, 84% (3.4 million) were provided to Indigenous clients, and 88% (3.6 million) were provided by ACCHOs (AIHW 2023; AIHW & NIAA 2022).

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 2018-19 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 6.1).

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 6.1: 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 6.2).

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 6.2).

Figure 6.2: 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

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.

As at December 2022, based on data from the Australian Immunisation Register (AIR), the proportion of Indigenous 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 Indigenous children who were fully immunised was higher than that of non-Indigenous children (96% compared with 94%).

The proportion of Indigenous 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 Indigenous children aged 2. While there was an overall improvement in immunisation coverage over the decade for Indigenous children aged 1 and 5, coverage rates decreased between 2020 and 2022, coinciding with the COVID-19 pandemic. The proportion of Indigenous children aged 1 who were fully immunised decreased from 94% in 2020 to 91% in 2022. For Indigenous children aged 5, the proportion who were fully immunised decreased from 97% in 2020 to 96% in 2022.

For further information, see:

• 3.02 Immunisation

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 Indigenous Australians aged 6 months and over received an influenza vaccination. Among older Indigenous adults, 43.5% of those aged 50–64 had an influenza vaccination in 2021, as did 64.6% of those aged 65–74, and 67.7% of those aged 75 and over.

In 2018–19, based on survey data, 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).

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 enables 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 2009–10 (Figure 6.3). The rate of increase has been higher among Indigenous Australians 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 Indigenous Australians, compared with 6.5 and 2.5 per 1,000 for non-Indigenous Australians, respectively).

Figure 6.3: Age-standardised rate of 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 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 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 2014b, 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, 2018

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

(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