Playing number games with Indigenous Australians' health

Achieving equity is less about grand gestures than meeting the actual needs of Indigenous Australians. Sorry by butupa/Flickr

The Australian Institute for Health and Welfare (AIHW) has released its latest report on how much money the Commonwealth and State governments spend on the health of Indigenous Australians. Despite being packaged as good news, there are fundamental problems with the messages contained in the report.

Aptly titled Expenditure on health for Aboriginal and Torres Strait Islander people, 2008–09, the report estimates that average health expenditure per person was $6,787 for Indigenous Australians in 2008–09, compared with $4,876 for each non-Indigenous Australian.

However, before congratulating the government on making progress toward more equitable treatment of Indigenous Australians, it’s important to note that despite its bandying around of impressive-looking figures, the report doesn’t reflect very much compared with the level of need.

It is the sixth installment in a series that started in 1998-99 with the inaugural report from John Deeble. This first report by Deeble provided an important baseline establishing just how much more was needed to ensure equitable treatment for Indigenous Australians.

It was a good start but the way expenditure is calculated changed with the last report so you can’t make any direct comparisons of data with anything earlier than that.

This is clearly problematic: if you change protocols half way through any long-term research project, you effectively reduce the value of what you’ve previously done.

If there were flaws in the earlier methodology then there was good reason to makes changes but it has also made comparisons with earlier reports redundant.

So, it’s interesting to note the report does exactly this in some of the good news it delivers in section 6.

This section shows a graph comparing health expenditure from 2001-2 through 2008-9. It’s a nice graph that illustrates things are going up but there’s clearly a contradiction here because these data are not supposed to be comparable and the report itself says this shouldn’t be done.

Some of the changes in methodology affect what is included as health expenditure and how it is calculated. It’s also important to note that most of the figures are estimates – they are approximations only.

Moving on to the figures themselves, the key point is that the total Commonwealth expenditure is about $1.39 for an Indigenous Australian for every dollar spent on a non-Indigenous Australian.

But if you look at the Pharmaceutical Benefits Scheme (PBS), the story changes. Here, an Indigenous Australian receive $0.58 for every $1 a non-Indigenous Australian receives out of the public purse for medications.

This is due to a whole host of reasons – from Indigenous people not being able to access services, to not being able to afford even subsidised medications and just not being prescribed the required drugs.

If you look at the combined figures for Medicare and PBS, an Indigenous person only gets $0.63 for every health dollar spent on a non-Indigenous Australian.

So ultimately, Indigenous Australians get fewer Commonwealth dollars spent on their health care from the scheme which is meant to ensure equitable access to health resources.

And when you look at the burden of disease within the community, Indigenous people should be getting two or three times as much spent on their health. That’s if you want to be equitable.

If you include State expenditure on Indigenous health, you get larger dollar ratios because State expenditure tops up Commonwealth expenditure.

The report documents a greater level of expenditure by States but it’s important to point out that there’s great diversity across these.

For instance, the money spent on Indigenous people in South Australia is three times as much as what is spent on non-Indigenous Australians.

But in the Australian Capital Territory (ACT), they don’t keep records on this kind of spending so you can’t see what happens there and Tasmania’s figures – at about 76 cents – is a very rough approximation.

So there’s clearly a quite a large variation across the various states and territories and it’s unclear how reliable the given state-level data is when not all states keep accurate records.

There’s detail buried in the report that is more worrying. For instance, Table 6.1 shows that Commonwealth expenditure increased from $1 billion in 2001 to $1.67 billion in 2008-9. This may well be so, but how the money is being distributed is perhaps of greater importance.

Aboriginal Community Controlled Health Organisations (ACCHO) are important providers of primary healthcare for Indigenous people and they are community run. Total expenditure by the Commonwealth has gone up by 65% in the last eight or nine years but expenditure on the Aboriginal community-controlled sector has only increased by 23%.

So a community-controlled sector delivering holistic, comprehensive and culturally appropriate health care to the community that controls it, which relies on Commonwealth funding is not seeing an increase in its funding at the equivalent level that the Commonwealth’s expenditure is rising.

Given ACCHOs are the first point of contact for many Indigenous people who have chronic diseases, this seems short-sighted. It’s really a pity that their funding has only gone up by less than a quarter whereas total expenditure has gone up 65%.

And, in the end, no matter how much good news the government congratulates itself with and how disparate data are dressed up, until we see levels of expenditure that reflect the level of health needs in Indigenous communities, we should hold off on any congratulations.

Until that happens, we will not bridge the gap in health inequities that separate Indigenous and non-Indigenous Australians.