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Out-Of-Pocket Costs in Australian Healthcare Submission 42

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Out-Of-Pocket Costs in Australian Healthcare Submission 42 Economic Value of Aboriginal Community Controlled Health Services Dr Katrina Alford 2 April 2014 “There is no national strategy for community health and there is considerable variation in the services provided across jurisdictions” (ROGS 2013: 11.3) “Every dollar that can be redirected into primary health care services, and particularly to ACCHS, from the public hospital system is money well spent” (Close the Gap Campaign Steering Committee 2013) “An investment in Aboriginal and Torres Strait Islander health, including to the Community Controlled sector, not only works towards curbing health disparities, but is also an investment in Aboriginal and Torres Strait Islander employment” (Royal Australian College of General Practitioners 2014) 1 Table of Contents List of Tables ...............................................................................................................................................................................................................3 Abbreviations ............................................................................................................................................................................................................ 4 Foreword ......................................................................................................................................................................................................................5 Key Messages .............................................................................................................................................................................................................7 Executive Summary ................................................................................................................................................................................................. 8 Introduction ............................................................................................................................................................................................................... 9 Recommendations .................................................................................................................................................................................................. 13 Section 1 - Overview ................................................................................................................................................................................................ 15 1.1 Health gaps ................................................................................................................................................................................................... 15 1.2 Government health policy ......................................................................................................................................................................... 15 1.3 Health outcomes .........................................................................................................................................................................................16 1.4 ‘ Four A’ barriers to access ...........................................................................................................................................................................18 1.5 Preference for Aboriginal-specific primary health care services (Tables 9, 11, 12, 13) ....................................................................19 1.6 Flawed administrative and resource allocation mechanisms .........................................................................................................20 1.7 Government funding issues .....................................................................................................................................................................20 1.7.1 Reducing Aboriginal health expenditure ...............................................................................................................................................27 1.7.2 Under-utilisation of mainstream services ............................................................................................................................................ 28 1.7.3 Mainstreaming government health expenditure ............................................................................................................................29 1.7.4 False economies: avoidable and expensive hospital service usage .............................................................................................29 1.7.5 Sustainability and reporting requirements ...........................................................................................................................................29 1.7.6 Distribution of primary health care funding .......................................................................................................................................30 (i) Rationale ...................................................................................................................................................................................................30 (ii) Specialised needs ..................................................................................................................................................................................30 (iii) Jurisdictional funding distortions .................................................................................................................................................30 (iv) Geographical funding distortions ................................................................................................................................................. 31 1.8 Economic costs of system failures .............................................................................................................................................................. 31 1.9 Transforming health outcomes with ACCHS .........................................................................................................................................32 1.10 Economic value of ACCHS ..........................................................................................................................................................................32 Section 2 - Aboriginal Primary Health Care Services (PHC) and Aboriginal Community Controlled Health Services (ACCHS): the evidence ................................................................................................................................................................................................................... 36 2.1 Data limitations .............................................................................................................................................................................................. 39 2.2 Aboriginal and Torres Strait Islander primary health care (PHC) services, 2001 —2011-12 (Tables 3-5, 7-10, 12, 13) ................. 39 2.3 Aboriginal Community Controlled Health Services, 2012-13 (Tables 14-17) ......................................................................................41 2.4 ACCHS workforce issues ............................................................................................................................................................................... 42 2.5 Evaluating ACCHS: government general performance indicators (Appendix 1) ............................................................................. 43 Section 3 - Case studies of Australian ACCHS ................................................................................................................................................. 47 Appendix 1 - Reports on Government Services (ROGS) General Performance Indicator Framework ............................................... 56 References ................................................................................................................................................................................................................ 58 2 List of Tables Table 1 Population: Aboriginal and Torres Strait Islander population, by remoteness, Australia, 2011 Table 2 Health: Aboriginal and Torres Strait Islander Health Survey, by remoteness, Australia, 2004-05 — 2012-13 Table 3 All government health expenditure: Aboriginal and Torres Strait Islander population, by main service type, per person, 2004-05 — 2010-11 Table 4.1 Australian government health expenditure, forward estimates, 2011-12 —2016-17 Table 4.2 Australian government health expenditure: forward estimates, 2011-12 — 2016-17 Table 5 All government health expenditure: mainstream, Indigenous-specific, per person, Australia, 2010-11 Table 6 All government health expenditure for Aboriginal and Torres Strait Islander people: intensity of use and cost of service, by State and Territory, Australia, 2010-11 Table 7 All government Indigenous health expenditure and hospital service expenditure, per person, ranking by State and Territory, 2010-11 Table 8 Aboriginal Primary Health Care (PHC) sector: distribution of services, clients, population, all government expenditure, by State and Territory, 2011-12 Table 9 Aboriginal PHCs: services, population, Australia, 2001—2011-12 Table 10 Aboriginal PHCs: distribution of services, clients, staff, ACCHS grants, population, by remoteness, Australia, 2011-12 Table 11 Aboriginal and Torres Strait Islander service use: GPs, dentists, hospital casualty/outpatients, Australia,
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