Stark evidence about the need to address health inequalities is revealed in the latest report from the National Health Performance Authority, according to Carol Bennett, CEO of the Consumers Health Forum.
In the article below, she suggests that the report’s findings add weight to arguments for a greater focus on strengthening primary healthcare.
Report highlights important differences in access to health services
Carol Bennett writes:
The national media largely failed to pick up on the remarkable differences in population health status, and in availability and use of health services, revealed by the latest National Health Performance Authority (NHPA) Report.
Perhaps because it lacked an easily digestible focus, or “angle”, the story failed to stir much national attention.
Yet the report provides the starkest evidence yet that despite our “universal” health system, there are considerable variations in Australians’ access to health care.
Australia has tended to look at health policy through a national lens, driven presumably by the ubiquity of Medicare and PBS services and state hospitals.
But the NHPA is providing the deepest focus yet on how different regions are faring and comparing the state of primary health care in the 61 Medicare Locals.
While areas like country South Australia with the poorest health in the country, (as measured by long term health conditions), has a relatively low use of doctors, we see the reverse in “healthier” areas.
The noteworthy paradox is that archetypal domain of the “battler”, Western Sydney.
Residents in the Medicare Local area there, who have better than median health status, have the highest use of GPs, the lowest number of people delaying GP visits because of cost and the highest GP bulk billing rate.
This all round favourable situation also extends to access and costs experience in relation to dentists, specialists and prescriptions. And they have about average use of hospitals.
Contrast that with the 14 Medicare Local areas where a quarter or more of residents have delayed or avoided seeing a dentist in the past year due to cost, and another 32 areas where at least one in 10 residents have put off either seeing a doctor or filling a prescription, or both.
In 20 Medicare Local areas, 10 per cent or more of people delayed or avoided filling a prescription due to cost. In 17 areas ten per cent or more residents delayed seeing a medical specialist and there were 11 areas where ten per cent or more delayed or avoided seeing a GP.
There will be any number of judgements about what constitutes reasonable access to services in Australia. But it is hard to escape notions of equity when it comes to spending of public money on health services.
So far, it appears, at least from a Canberra perspective, that this locally drawn health data create little discomfort for the federal government.
But should not the gulf exposed in some areas of relatively low health status and availability of services demand closer attention?
NHPA CEO Dr Diane Watson says the percentage of adults with long-term health conditions varied from 34 per cent to 60 per cent, depending on Medicare Local area.
The local populations “in parts of the country where people have the poorest health were no more likely to have seen a doctor or dentist in the past year,” Dr Watson said.
She does concede that there may be other practitioner groups, such as community nurses, who may be meeting patient needs but were not covered by this report.
The strategic significance of such a report is that it strengthens the significance of primary health care. Too often, for political purposes at least, the hospital takes the dominant place in local health care.
Local data such as this report may generate greater focus on primary health care and the need for a more concerted approach to meeting local needs.
Whether or not a Coalition Government would retain Medicare Locals, the emergence of a detailed picture of “healthcare in the neighbourhood”, will likely mean continued support for a stronger primary care system — whatever form that takes.
The NHPA’s MyHealthyCommunities website is at: www.myhealthycommunities.gov.au
• Carol Bennett is CEO of the Consumers Health Forum