MEDICARE reform that supports GP advocacy for Aboriginal and Torres Strait Islander patients is crucial to finally closing the gap and eliminating systemic racism in Australia’s health care system, say experts.
In an editorial published by the MJA, Professor Lilon Bandler, a GP and Principal Research Fellow at the Leaders in Indigenous Medical Education Network, and Dr Talila Milroy, a GP and academic registrar with the University of Western Australia, wrote that “general practice must be the cornerstone for restructuring Indigenous health policy, and this must include reforming Medicare”.
“As GPs, we see how health care in Australia fails to adequately serve Aboriginal and Torres Strait Islander Australians,” Milroy and Bandler wrote.
In 2020, the federal government changed its approach to the Closing the Gap policy, pivoting to “the incorporation of Indigenous perspectives into health care, and greater control of health-related targets and programs by Indigenous-led organisations”.
“We see the risks associated with the new Closing the Gap policies in community primary health care,” wrote Milroy and Bandler.
“The social determinants of health have long been clear, but the model of care expected of Australian GPs does not acknowledge that housing, food security, and protection from the effects of climate change are as important as a referral to a podiatrist when managing someone with diabetes.”
Speaking in an exclusive InSight+ podcast, Professor Bandler said that Medicare reform was vital to supporting Indigenous health.
“One of the things that draws my attention to Medicare is that it doesn’t reward sitting and listening and taking time,” Professor Bandler said.
“That, particularly for Aboriginal and Torres Strait Islander patients and their families, is a real problem. They will report this sense of being hurried through and being part of the churn of the day-to-day business of a practice.
“And the reality is that for private practices, [with Medicare as it is,] it is important to see a lot of patients to make it financially viable.
“It also goes to some issues around the complexity of many Aboriginal and Torres Strait Islander patients’ health care. So, any patient who has a complex medical history will probably identify with that, but those people are over-represented in Aboriginal and Torres Strait Islander patients.”
Both Milroy and Bandler acknowledged that they were asking big questions of the Australian Government and society in general.
“We are talking systemic racism,” said Professor Bandler.
“We are asking huge things of Australia more broadly. And that is reflected in what we ask of an Australian federal government. The challenge of that is for Australian society and for the Australian federal government as the representatives of that society. And that is why asking for change is something you grow gray hairs doing.”
Professor Bandler told InSight+ that there were “steps along the way”.
“The health care professionals in Australia are thinking about culturally safe care and how they reflect on their own practice and what that means in terms of how they might change their practice, and how they might reflect on their values and their impact on Aboriginal and Torres Strait Islander patients.
“We also recognise that it’s not just about policy.
“It is about people and how people live and interact with their health care professionals. That it is complex and difficult.”
Medical education, not just of Indigenous students and junior doctors, but also of their supervisors and mentors, remains an area full of challenges.
Dr Milroy told InSight+ that even though “Indigenous doctors relate really well with Indigenous patients … it’s been hard to grow this sector”.
“We have streamlined pathways for Indigenous people to move into medical and health-related fields through universities, but there are barriers to people progressing after they graduate into specialty training,” she said.
“Racism is thought to be a big contributor to that. It’s talking about supervisors who may not be aware of the issues that their Indigenous trainees might be experiencing with their training.
“This might include things like racism directed from patients in day-to-day practice and how they deal with that; also access to culturally appropriate mentorship. Colleges are trying to improve that, but if there’s not a lot of people to provide that mentorship at the top, then then you have difficulties when you’ve got a lot of trainees who need that support.
“So again, it’s about system change.
“We need to address the issues of racism across health care, education, training, and health care delivery to support trainees and to support these culturally safe workplaces.”
In concluding their MJA editorial, Milroy and Bandler wrote that:
“The benefits in closing these gaps go beyond fulfilling a policy agenda, providing new health services, or establishing new programs. It means future generations of Indigenous Australians who live longer, who thrive rather than survive, and who are recognised as valued members of the society and country they own.”