Budget threat to Indigenous health

THE 2014 federal Budget has the potential to “decimate” quality primary health care for Indigenous Australians, says the president of the Australian Indigenous Doctors’ Association.

Dr Tammy Kimpton, a GP practising in Scone, NSW, said she was “deeply disappointed but unsurprised” by the Budget, which included plans for a $7 copayment on GP visits, pathology tests and imaging, as well as a $165 million cut to Indigenous health programs (1)

“The current $7 copayment proposal has the potential to decimate good quality primary care for Indigenous Australians”, Dr Kimpton told MJA InSight.

She was responding to research published online by the MJA on the cost-effectiveness of primary care for Indigenous Australians with diabetes living in remote Northern Territory communities. (2)

The researchers used data over a 10-year period for 14 184 Indigenous residents aged 15 years and older with diabetes who attended any of 54 clinics in remote communities, and five public hospitals, to measure hospitalisations, potentially avoidable hospitalisations (PAH), mortality and years of life lost (YLL).

They found that compared with patients who had a low use of primary care (0–1 visits to primary care per year), those with medium primary care use (2–11 visits per year) had lower rates of hospitalisation, lower PAH, lower death rates and fewer YLL. Among complicated cases (patients with one or more diabetes complications), the medium group showed a significantly lower mean annual hospitalisation rate (1.2 v 6.7 per person) and PAH rate (0.72 v 3.64 per person).

The death rate (1.25 v 3.77 per 100 population) and YLL (0.29 v 1.14 per person-year) were also significantly lower.

The researchers wrote that, based on financial figures from 2007–2008 and 2008–2009, the primary care-related cost of preventing one hospitalisation for diabetes was $248 for those in the medium-use group and $739 for those in the high-use group (12 or more primary care visits per year). “In both cases the cost was much less than the mean cost of one hospitalisation, $2915”, they wrote.

“Improving access to high-quality primary care in remote communities for the management of diabetes results in net health benefits to patients and cost savings to government”, the researchers concluded.

Dr Kimpton said the research provided a timely and strong argument for maintaining resources in general practice for Indigenous communities.

“It’s very reassuring to see good research showing the benefits of quality primary care in terms of reducing costs in the long term”, she told MJA InSight.

“However, particularly in terms of the management of chronic diseases like diabetes, for which numerous visits to the GP, good regular medications and frequent pathology tests are necessary, this [copayment policy] is potentially destructive.”

Professor Ngaire Brown, deputy chair of the Prime Minister’s Indigenous Advisory Council and codirector of the Poche Centre for Indigenous Health at the University of Sydney, told The Australian newspaper last week that little thought had been given to the consequences of the copayment on “closing the gap” programs. (3)

“I don’t think there has been consideration of any kind for the financial, economic or social impacts or the intended and unintended consequences of co-payments”, she told the newspaper.

“The policy makers need to think very carefully about whether to go ahead with the co-payment and if they do, who will pay and who will have exemptions.

“It is already difficult enough for the Aboriginal community-controlled health sector to provide comprehensive care on the limited resources that we have”, Dr Brown said.

In a statement on Indigenous health services released last week, federal Health Minister Peter Dutton said the “Australian Government has a strong commitment to front line, core essential health service delivery, reducing red tape overheads and better supporting efforts to achieve health equality between Indigenous and non-Indigenous Australians”. (4)

“The Government will be spending almost one billion dollars on specific Indigenous health programmes, Medicare and PBS items. This includes $520 million in grant funding for Indigenous health organisations in 2014-15”, Mr Dutton said in the statement.

“Given the amount of money being administered by Indigenous health services I am keen to get a better understanding of the concerns being raised and of how the funding is being translated into front-line support.”

The National Aboriginal Community Controlled Health Organisation (NACCHO) was contacted for comment but did not respond by publication deadline.

In a speech to the Criterion Conference on Indigenous employment last week, Warren Mundine, chair of the Indigenous Advisory Council, said the government “felt a reduction in the total [Indigenous affairs] budget was necessary but has preserved 95.5% of the budget which still provides substantial scope for reinvestment and refocus”. (5)

1. ABC News 2014; Online 16 May
2. MJA 2014; Online 26 May
3. Australian 2014; Online 22 May
4. Minister for Health 2014; Indigenous Health Services; Online 20 May
5. Warren Mundine; Speech to Criterion Conference: Indigenous employment; 20 May 2014