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Provision of Health Services to Aboriginal Communities in the Northern Territory

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Provision of Health Services to Aboriginal Communities in the Northern Territory LEGISLATIVE ASSEMBLY OF THE NORTHERN TERRITORY PUBLIC ACCOUNTS COMMITTEE REPORT ON THE PROVISION OF HEALTH SERVICES TO ABORIGINAL COMMUNITIES IN THE NORTHERN TERRITORY REPORT NUMBER 28 NOVEMBER 1996 Presented and Ordered to be printed by the Legislative Assembly of the Northern Territory on 28 November 1996 Report on the Provision of Health Services to Aboriginal Communities in the Northern Territory _____________________________________________________________________________________ LEGISLATIVE ASSEMBLY OF THE NORTHERN TERRITORY PUBLIC ACCOUNTS COMMITTEE REPORT ON THE PROVISION OF HEALTH SERVICES TO ABORIGINAL COMMUNITIES IN THE NORTHERN TERRITORY REPORT NUMBER 28 NOVEMBER 1996 _________________________________________________________________________________________ _ iii Public Accounts Committee ________________________________________________________________________________________ MEMBERS (in attendance during inquiry) Mr Rick Setter, MLA (Chairman) Mr John Bailey, MLA Mrs Loraine Braham, MLA Mr Denis Burke, MLA Mr Brian Ede, MLA Mr Phil Mitchell, MLA Mr Peter Toyne, MLA Legislative Assembly of the Northern Territory PUBLIC ACCOUNTS COMMITTEE GPO Box 3721 Darwin NT 0801 Level 3, Parliament House Telephone: (08) 89461 459 Mitchell Street Facsimile: (08) 89816 158 Darwin NT 0800 Email [email protected] __________________________________________________________________________________________ ii Report on the Provision of Health Services to Aboriginal Communities in the Northern Territory _____________________________________________________________________________________ CONTENTS Page No. LIST OF TABLES ix NORTHERN TERRITORY PUBLIC ACCOUNTS COMMITTEE xii STATUS OF THE COMMITTEE xii DUTIES OF THE COMMITTEE xii COMMITTEE MEMBERS in attendance during Inquiry xiii TERMS OF REFERENCE xv CONDUCT OF INQUIRY xvi CHAIRMAN’S FOREWORD xvii PREAMBLE xviii EXECUTIVE SUMMARY xx COMMITTEE’S RECOMMENDATIONS xxvi CHAPTER 1 1 1. TERMS OF REFERENCE (A) 1 if common goals have or can be established as the basis for an efficient management framework 1 1.1 Introduction 1 1.2 Existing Goals for Providers and Funding Agencies 1 1.2.1 National Health Policy - 30 September 1994 1 1.2.2 Aboriginal Health Framework 3 1.3 Territory Health Services Corporate Plan 1993/95 4 1.3.1 Goals 4 1.3.2 Territory Health Programs 5 1.4 Territory Health Services - Background Information 7 1.5 Common Goals - Lack of Co-ordination 9 1.6 ATSIC Health Services pre–July 1995 11 1.7 Transfer of Health from ATSIC to Department of Health and Family Services (Commonwealth) 12 __________________________________________________________________________________________ iii Public Accounts Committee ________________________________________________________________________________________ 1.8 Health Providers 13 1.8.1 Catholic Health Care, Darwin 13 1.8.2 Santa Teresa - Alice Springs 13 1.8.2.1 Catholic Health Care (Northern Territory) 13 1.9 Process used to determine Goals and Priorities 14 1.9.1 Territory Health Services 14 1.9.2 Aboriginal Health Policy 15 1.9.3 Commonwealth Funded Services 16 1.9.4 Commonality of goals and inconsistencies in goals 17 1.10 Catholic Health Care - Santa Teresa - Alice Springs. 18 1.11 National Aboriginal Health Strategy - Evaluation 18 1.11.1 NT Tripartite Forum 19 1.12 Commonality of goals 20 1.13 Comparison of goals 20 1.14 Two Major Differences 20 1.15 Input from the Menzies School of Health Research (Menzies) 22 1.16 Community Involvement is vital for Change 23 1.17 Goal Setting at the Community Level 24 1.18 Goal Setting - Task Force 24 1.18.1 Terms of Reference 24 1.18.2 Membership 25 1.18.3 Guidelines 25 1.18.4 Time Frame and Evaluation 25 1.19 Priority Setting 26 CHAPTER 2 27 2. TERMS OF REFERENCE (B) 27 the impact of services currently provided and any gaps and/or duplication of services 27 2.1 Introduction 27 2.2 Health Services For Aboriginal Communities 27 2.3 Range of Services provided 27 2.4 NT and Commonwealth grant funded health care service providers 28 2.5 Services provided by grant funded health care providers 28 2.6 Commonwealth Department of Health & Family Services 29 2.7 The existing framework/models that each provider is working to in the provision of health services to Aboriginal communities. 29 2.8 Health Framework 33 2.8.1 Primary Health Care 34 2.8.2 Impact of Health Initiatives 35 __________________________________________________________________________________________ iv Report on the Provision of Health Services to Aboriginal Communities in the Northern Territory _____________________________________________________________________________________ 2.9 Commonwealth Department of Health and Family Services 41 2.9.1 Rural Incentives Program 43 2.9.2 Primary Health Care & Aboriginal Community Controlled Organisations 43 2.10 An Alternative Aboriginal Health Care framework/model 44 2.11 Community Control 47 2.12 Involvement in Health Services for Indigenous Peoples of Canada and New Zealand - Introduction 48 2.12.1 Canada 48 2.12.2 New Zealand 50 2.12.3 Conclusion 51 2.13 Council of Australian Government (COAG) - The Three Streams 51 2.14 Comparisons of Existing Models and Related Services within the Northern Territory 53 2.15 Community Driven Services 56 2.16 Duplication of Services/Resources 58 2.17 Goal Setting Commonwealth/Northern Territory 58 2.18 Gaps in Health Services 60 CHAPTER 3 62 3. TERMS OF REFERENCE (C) 62 the effectiveness of services being provided and whether present service delivery mechanisms are relevant 62 3.1 Introduction 62 3.2 Feedback from Communities and Providers 62 3.3 Key Indicators to Measure the Effectiveness of Health Services Being Provided 63 3.3.1 Rural/Urban Comparison 63 3.4 Trends in Health Outcomes 66 3.4.1 Pregnancies 66 3.4.2 Births and Birthweight 66 3.4.3 Mortality-Life Expectancy 67 3.4.4 Injury and Poisoning 69 3.4.5 Homicide and Injury Purposely Inflicted by other Persons 69 3.4.6 Mortality-Infant Mortality 69 3.4.7 Mortality-Age Specific Mortality 70 3.4.8 Infectious & Parasitic Diseases 70 3.4.9 AIDS/STD (Sexually Transmitted Diseases) 70 3.4.10 Non-communicable diseases 71 3.4.11 Renal disease 74 3.4.12 Alcohol Misuse 75 3.4.13 Tobacco related ill-health 76 3.4.14 Other Substance Abuse 76 3.4.15 Neoplasms (Cancers) 76 3.4.16 Nutritional Deficiencies 76 3.5 Assessment of Health by Indigenous Australians 78 __________________________________________________________________________________________ v Public Accounts Committee ________________________________________________________________________________________ 3.6 Evaluation Processes 79 3.6.1 Building in Access and Equity 82 3.7 Adequacy and Availability of Statistics and Information 83 3.7.1 Aboriginal Deaths in Custody 84 3.7.2 Territory Health Services Information/Statistics 84 3.7.3 Health Infrastructure Priority Projects (HIPP) 86 3.7.4 Community Care Information Systems Project 88 3.7.5 Commonwealth Health 89 CHAPTER 4 92 4. TERMS OF REFERENCE (D) 92 the cost efficiency of service delivery mechanisms and whether more cost-efficient solutions are available 92 4.1 Introduction 92 4.2 Submissions 92 4.3 Efficiency 93 4.4 Ilan Warchivker’s (1995) Expenditure Study of Rural Communities. 95 4.5 Efficiency in Health 101 4.6 Use of the Health Economics Tools 104 4.7 NT Auditor-General’s Report to the Legislative Assembly August, 1995. 110 CHAPTER 5 112 5. TERMS OF REFERENCE (E) 112 the adequacy of funding arrangements between the Commonwealth and the Northern Territory involved in the delivery of those services 112 5.1 Introduction 112 5.2 Submissions 112 5.3 Overview of NT Funds - Commonwealth Grants Commission 115 5.3.1 Grants from the Commonwealth 115 5.3.2 Total Commonwealth Grants 116 5.3.3 April 1995 Premier’s Conference 116 5.3.4 General Current-Purpose Grants 116 5.3.4.1 Financial Assistance Grants 116 5.3.4.2 Specific Purpose Grants 117 5.4 Territory Health Services 119 5.5 Aboriginal and Non-Aboriginal Health Expenditure 123 5.5.1 Pharmaceutical Benefits 125 5.6 Urban and Rural Health Expenditure 131 5.7 Equity 131 __________________________________________________________________________________________ vi Report on the Provision of Health Services to Aboriginal Communities in the Northern Territory _____________________________________________________________________________________ 5.8 Disability Factors - Commonwealth Grants Commission 133 5.8.1 Dispersion 134 5.8.2 Age 134 5.9 Medical Benefits Scheme and Pharmaceutical Benefits Scheme Shortfall 134 5.9.1 Option 1: Seek a special grant from the Commonwealth 135 5.9.2 Option 2: Commonwealth Grants Commission to seek Commonwealth approval of a new disability factor ‘environmental factor’ to compensate for lack of access to General Practitioner services. 136 5.9.3 Option 3: That Medicare benefits access for standard consultation be made available to other community health professionals 136 5.10 Relationship between Acute Care and Community Health Programs 137 CHAPTER 6 140 6. TERMS OF REFERENCE (F) 140 strategies for achieving co-operation from the principal participants 140 6.1 Introduction 140 6.2 Communities and Government Agencies 140 6.3 Co-operation between the NT Agencies and ATSIC (Health Issues) 143 6.4 Co-operation between ATSIC and the Commonwealth Department of Health and Family Services 143 6.5 Co-operation between Territory Health Services and Commonwealth Department of Health and Family Services 145 6.6 Telemedicine 149 6.7 Three Streams of Health Care 150 6.8 Cooperation between Territory Health Services and Aboriginal communities
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