Aniello Iannuzzi: Gap challenge

WE don’t need a list of 50 references to tell us that the health of our Aboriginal and Torres Strait Islander peoples is a blight on Australia’s reputation as a resource-rich nation with a first-rate health system.

The problem of poor Indigenous health outcomes cannot be blamed solely on our health system — geographical, cultural, legal, educational, economic and other social determinants all play a role.

However, as participants within Australia’s health sector, health professionals have a duty to reflect on how matters can be improved.

A good way to approach this is to contemplate a time when we or one of our loved ones has been sick. Even as doctors — replete with knowledge of “the system” and our networks of colleagues — it can take considerable time, phone calls and paperwork to get things done where we want, how we want and when we want.

GPs know better than anyone else that the role of the doctor is becoming less of diagnostician/curer and more of a manager/coordinator/facilitator. It is now just as important to learn about how the health system works as it is about the diseases themselves.

Now, put yourselves in the shoes of the vast majority of Indigenous patients in Australia. Not only would you be confronted with the maze of the health system, but often also with a lack of money, transport, education and experience to deal with being sick in Australia.

Those of us who work in rural and remote areas are confronted with this not just daily, but many times per day.

The result is that many Indigenous patients simply do not access our health system and all it has to offer. When contact is made, it is often sporadic with little or no continuity — often scripts are not filled, referrals are not followed up, children are not vaccinated, etc.

In 2008, the Australian Government endorsed the Closing the Gap (CTG) initiatives. Among the programs and schemes introduced, referrals to allied health services are now much easier and many Indigenous patients now get Pharmaceutical Benefits Scheme (PBS) prescriptions free or significantly cheaper.

Now prescriptions for sick children are much more likely to be filled by mothers who no longer have to wait for “pay day” (pension day). In my practice, the positive effect of the PBS incentive alone has been dramatic.

But as successful as it has been, there is so much more to do …

To register for CTG incentives, there is still a mountain of paperwork for the patient and the practice. There is a requirement to re-register annually. There is still no dental component to the scheme.

As with many other such schemes, the CTG highlights the awkward disconnect between our state-run hospitals and Medicare. For example, a script written in hospital is not eligible for a CTG annotation, so an Aboriginal patient given a script for antibiotics following an admission for pneumonia cannot get the cheaper rate with the hospital discharge script.

A better way forward would be a system that allows unrestricted access to the full range of services available in our health system.

My experience in treating many Indigenous patients over the years has taught me that unrestricted access to all levels of our system would, in fact, save time and money, as well as achieve better outcomes.

If we gave Indigenous patients a special Medicare card — similar to a Department of Veterans’ Affairs Gold Card — this would allow cheaper scripts, full allied health care, an increased range of dental, eye and nursing services, transport assistance, and access to private hospital facilities.

Some would argue that this singles out one group in our society when so many others are also needy. This is valid, but we cannot escape the fact that we need to make a start and that this group is very much in need.

Others may argue that it would be too expensive and unaccountable. I beg to differ. When taking into account the paperwork, costs and inefficiencies of the current schemes, an unrestricted scheme would in fact be cheaper, even if the odd bit of overservicing occurred (and let’s be honest enough to admit it occurs under current schemes anyway; eg, the Chronic Disease Dental Scheme that is set to be replaced in the near future).

If, after 10–20 years, we have sufficiently closed the gap, we could always reassess and scale it back.

Could you imagine being able to refer Indigenous patients wherever we liked, in a timely fashion, knowing that they would get there and have the treatment needed?

Now that would be revolutionary and truly close the gap!

Dr Aniello Iannuzzi is a GP practising in Coonabarabran, NSW.

Posted 22 October 2012