Couzos, Sophia (2001) Medicare rebate for the 'health assessment of Aboriginal and Torres Strait Islander persons': proposal to benefit Aboriginal health (2001). Report. National Aboriginal Community Controlled Health Organisation, Canberra, ACT, Australia.

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Abstract

[Extract] EXECUTIVE SUMMARY In this paper, the National Aboriginal Community Controlled Health Organisation(NACCHO), the peak Aboriginal health body in Australia, has described the importance of primary health care activity incorporating all types of preventive interventions, not just tertiary prevention for Aboriginal populations.

Efforts by the Federal Government to enhance the effectiveness of Medicare to reward preventive health activity have been welcomed by NACCHO. The new Enhanced Primary Care (EPC) items offer service providers more appropriately structured remuneration for several aspects of work commonly undertaken in Aboriginal primary health care services.

However, only a limited number of Aboriginal people can benefit from these Medicare rebates, as they are currently structured. Firstly, these new Medicare items reward health assessments or health checks for the elderly. The elderly were defined as people over the age of 75 years or over the age of 55 years if Aboriginal or Torres Strait Islander. Secondly, the Care Plan items are valid for all regardless of age, but are an investment in tertiary prevention only. They aim to reward practice that will prevent worsening of chronic disease and hospitalisation for those who are already known to have chronic disease. There is no financial incentive of any kind, which rewards primary and secondary prevention of chronic disease.

There is a need for an incentive to encourage and reward broad GP involvement in best practice pertaining to Aboriginal health. This is especially urgent given that there is a high burden of unidentified chronic illness in the Aboriginal population, and this illness is preventable based on good evidence, and interventions to high-risk populations is costeffective.

NACCHO, with the support of the Australian Medical Association, Divisions of General Practice, the General Practice Partnership Advisory Council and the EPC Taskforce recommends a Medicare Rebate for a health check in an Aboriginal adult (regardless of age) which should be available for any doctor to claim. This is otherwise known as a 'well persons health check'. Any Aboriginal person should have a right to expect and receive such a comprehensive service.

Such a Rebate has the potential to generate savings over and above the foregone fee-for-service activity. It would provide for streamlined, cost-effective administration of investments in prevention for Aboriginal health, compared with current or alternative mechanisms. Early identification and intervention for chronic disease in the primary care setting will reduce the need for care in the acute hospital sector, with a concomitant reduction in downstream costs. As a result of increased primary and secondary prevention of disease in Aboriginal populations, investments in tertiary prevention (Care Plans) would yield better returns.

In 1995-7 there were over 51,000 years of potential Aboriginal life lost before age 65 years due to premature deaths. The excess burden of chronic disease and the high rate of premature deaths in the Aboriginal population require urgent investments in preventive activity at the primary health care level.

There are a number of levers the Federal Government could introduce to foster improvements in clinical practice, discourage inappropriate practice and enhance health outcomes for the Aboriginal community. This paper compares and contrasts current Federal Government initiatives aimed at fostering improvements in immunisation activity with the relative lack of initiatives fostering primary and secondary prevention of chronic disease in Aboriginal populations.

Aboriginal people carry the excess burden of disease and consequent financial and health costs fall on those that are least able to afford it. A health system that perpetuates the free market provision of preventive health care ('laissez faire' approach) perpetuates inequity. The health profession needs to enable preventive health interventions to those who are least able to ask for it. This underlies the need for interventionist options

A number of options are presented to assist the Commonwealth Department of Health and Aged Care in planning for future activity to foster improvements in Aboriginal health. Underpinning all these options is the development of a Medicare Rebate for the health assessment for Aboriginal adults (of any age) as an investment in primary and secondary prevention at the practice level.

Item ID:	40640
Item Type:	Report (Report)
Keywords:	Aboriginal, Medicare, rebate, health check, health assessment, item 715, item 710, aged care, Puggy Hunter, NNT, evidence-base, kidney, heart, smoking, Pap smear, prevalence
Related URLs:	Organisation
Additional Information:	This submission prepared on behalf of the National Aboriginal Community Controlled Health Organisation was submitted to the Department of Health and Ageing in Canberra in May 2001. It was part of the advocacy undertaken to support the introduction of a new Medicare Rebate for the adult health check of Aboriginal peoples and Torres Strait Islanders. This was successful.
Date Deposited:	13 Dec 2016 23:30
FoR Codes:	11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111717 Primary Health Care @ 50% 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111701 Aboriginal and Torres Strait Islander Health @ 50%
SEO Codes:	92 HEALTH > 9203 Indigenous Health > 920302 Aboriginal and Torres Strait Islander Health - Health Status and Outcomes @ 100%
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