Aboriginal and Torres Strait Islander Access to Major Health Programs November 2006 Urbis Keys Young Prepared for Medicare Australia and the Department of Health and Ageing Aboriginal and Torres Strait Islander Access to Major Health Programs November 2006 Urbis Keys Young Prepared for Medicare Australia and the Department of Health and Ageing Reference Group Membership • Aboriginal Health Worker representative • Australian Indigenous Doctors Association (AIDA) • Australian Medical Association (AMA) • Congress of Aboriginal and Torres Strait Islander Nurses (CATSIN) • General Practice Representative Group (GPRG) • Medicare Australia (formerly the Health Insurance Commission) • National Aboriginal Community Controlled Health Organisation (NACCHO) • Office for Aboriginal and Torres Strait Islander Health (OATSIH) • Pharmacy Guild of Australia • Queensland Aboriginal and Islander Health Council (QAIHC) • Rural Doctors Association of Australia Working Group Membership • Centrelink • Department of Health and Ageing (Pharmaceutical Access and Quality) • Department of Health and Ageing (Practice Incentives and Alternative Funding Section, General Practice Programs Branch) • Department of Health and Ageing (Primary Care Policy Branch) • Medicare Australia (Indigenous Access Program and Medicare Business Support Section) • Medicare Australia (Medicare and Department of Veterans’ Affairs Branch) • Medicare Australia (Program Delivery – PBS) • Office for Aboriginal and Torres Strait Islander Health (Policy and Analysis Branch) - Department of Health and Ageing • Office of Indigenous Policy Coordination (Policy Innovation) - Department of Family, Community Services and Indigenous Affairs Aboriginal and Torres Strait Islander Access to Major Health Programs - Urbis Keys Young - 2006 Acknowledgements The consultants gratefully acknowledge the considerable support and assistance provided by staff at the Aboriginal and Torres Strait Islander Health Services which participated in this study and the contributions made by community members consulted in the course of the research. We hope that their experiences and views are clearly reflected in this report. Sincere thanks also go to the members of both the Working Group and the Reference Group who made invaluable contributions throughout the study. Finally our thanks to the hundreds of health professionals and administrators - including Aboriginal health workers, nurses, doctors, pharmacists and Medicare Australia staff - who generously contributed their time and wealth of experience to this research. We trust and believe that this work will contribute, in some small way, to the improved health and wellbeing of Aboriginal and Torres Strait Islander peoples. The images used for this publication have been selected from a collection of photographs that were taken for use in the Healthy for Life Program. The Department of Health and Ageing acknowledges and thanks the many people who participated in the photo shoots and gave permission for the images to be used in departmental publications. Aboriginal and Torres Strait Islander Access to Major Health Programs - Urbis Keys Young - 2006 Table of Contents Reference Group Membership Working Group Membership Acknowledgements Glossary Executive Summary i Recommendations v 1 This study 1 1.1 Background 1 1.2 Objectives and scope 2 1.3 Methods 4 1.3.1 Introduction 4 1.3.2 Reference to existing literature and data 4 1.3.3 Analysis of OATSIH and Medicare data 6 1.3.4 Stakeholder consultation 6 1.3.5 Field visits 7 1.3.6 Survey research 8 1.4 This report 8 2 Medicare Information and Enrolment 9 2.1 Introduction 9 2.2 Aboriginal and Torres Strait Islander Enrolment in Medicare 9 2.3 Voluntary Indigenous Identifier 12 2.4 Medicare Liaison Officers for Indigenous Access and Indigenous Specialist Information line 12 2.4.1 Medicare Liaison Officers for Indigenous Access 12 2.4.2 Specialist Indigenous Access Line 13 2.4.3 Opinions about these services 14 2.5 Summary 17 3 Use of Medicare by Aboriginal and Torres Strait Islander Health Services 18 3.1 Introduction 18 3.2 Exemption under Subsection 19(2) of the Health Insurance Act 1973 18 3.3 OATSIH and Medicare funds 19 3.4 Claiming Medicare rebates 21 3.5 Role of Medicare in Indigenous health services 2 3.6 Services provided by Practice Nurses and Aboriginal Health Workers 28 3.7 Enhanced Primary Care items 28 3.8 Practice Incentives Program 31 3.9 Immunisation 35 3.10 Hearing services 37 3.11 Point of care diabetes testing and the National Diabetes Services Scheme 40 3.11.1 Point of care testing for diabetes 40 3.11.2 National Diabetes Services Scheme 41 3.12 Rural and Remote Health Initiatives 43 3.13 Other Matters 44 3.14 Summary 44 Aboriginal and Torres Strait Islander Access to Major Health Programs - Urbis Keys Young - 2006 4 Access to Medicare through Mainstream Health Services 46 4.1 Use of mainstream services 46 4.2 Training of practitioners 48 4.3 Use of EPC items in General Practice 49 4.4 Survey of GPs 49 4.4.1 Characteristics of the practice 50 4.4.2 Numbers of Indigenous patients 50 4.4.3 Recording of information 51 4.4.4 Charging for services 51 4.4.5 Medicare 51 4.4.6 EPC items 52 4.4.7 Practice Incentives Program 53 4.4.8 Length of appointments 53 4.4.9 Specialist referrals 54 4.4.10 Medications 54 4.4.11 Rural Health Strategy 54 4.4.12 Training or experience in Indigenous health 55 4.4.13 Possible innovations or changes 55 4.5 Specialist medical services 56 4.6 Summary 58 5 Access to Medications under the Pharmaceutical Benefits Scheme (PBS) 59 5.1 Introduction 59 5.2 Section 100 of the National Health Act 1953 and the 2003 review 59 5.3 Role of community pharmacies 62 5.3.1 Community pharmacist perspectives 62 5.3.2 Survey of community pharmacies 64 5.4 The PBS Safety Net 68 5.5 Medications on discharge from hospital 69 5.6 Quality Use of Medicines 69 5.6.1 General 69 5.6.2 Home Medicines Review 71 5.7 Access to a wider range of pharmacy support 72 5.8 Medications covered by the PBS 72 5.9 Possible initiatives to improve access to the PBS 72 5.10 Summary 75 Key References 76 Case Studies 78 Appendices Located online at http://www.health.gov.au/oatsih Aboriginal and Torres Strait Islander Access to Major Health Programs - Urbis Keys Young - 2006 Glossary ACCHS Aboriginal Community Controlled Health Service ACIR Australian Childhood Immunisation Register AHW Aboriginal Health Worker ATSIHS Aboriginal and Torres Strait Islander Health Service CDEP Community Development Employment Program CDM Chronic Disease Management CHSP Commonwealth Hearing Services Program DHCS Department of Health and Community Services (Northern Territory) DoHA Department of Health and Ageing EPC Enhanced Primary Care GPII General Practice Immunisation Incentives HIC Health Insurance Commission MBS Medicare Benefits Schedule MLOs Medicare Liaison Officers for Indigenous Access MSOAP Medical Specialist Outreach Assistance Program NACCHO National Aboriginal Community Controlled Health Organisation NDSS National Diabetes Services Scheme OATSIH Office for Aboriginal and Torres Strait Islander Health OMPs Other Medical Providers OTD Overseas Trained Doctor PBS Pharmaceutical Benefits Scheme PHCAP Primary Health Care Access Program PIP Practice Incentives Program QUM Quality Use of Medicines RACGP Royal Australian College of General Practitioners S100 Section 100 of the National Health Act 1953 SAR Service Activity Reporting SIP Service Incentive Payment VACCHO Victorian Aboriginal Community Controlled Health Organisation Aboriginal and Torres Strait Islander Access to Major Health Programs - Urbis Keys Young - 2006 Executive Summary Nature and Purpose of this Study This study was conducted during 2005-06 for the Department of Health and Ageing (DoHA) and Medicare Australia. Its purpose was to provide an up to date picture of Aboriginal and Torres Strait Islander people’s access to major health programs. The work included consideration of a range of Australian Government initiatives that have been implemented since the submission of an earlier report on Indigenous access to Medicare and the Pharmaceutical Benefits Scheme (PBS), prepared by Urbis Keys Young in 1997. The present study involved national stakeholder consultation, visits to twelve urban, regional and remote locations across Australia, statistical analysis and the conduct of four inter-related surveys with Aboriginal and Torres Strait Islander Health Services (ATSIHSs), community pharmacies, GPs and Medicare staff. Initiatives since 1997 This study confirmed that a number of initiatives that have been taken in recent years to improve Aboriginal and Torres Strait Islander access to Medicare and the PBS are widely seen as appropriate and valuable. These include: • the appointment of Medicare Liaison Officers for Indigenous Access within Medicare Australia; • establishment of a specialist free-call Indigenous Medicare information line; • increased use of an exemption under subsection 19(2) of the Health Insurance Act 1973 that enables Aboriginal and Torres Strait Islander Health Services in certain States and Territories (remote clinics) to claim Medicare rebates for services they provide; • Additional Medicare rebates for doctors who bulk bill certain services provided to eligible patients, eg health care card holders and children under 16 years. Higher incentive payments apply in eligible area including regional, rural and remote locations, • entitlement for GPs to claim Medicare rebates relating to certain tasks performed by nurses and, in the Northern Territory, by Aboriginal Health