Medicare and the vulnerable

Dr Tim SeniorGP Tharawal Aboriginal Corporation

RACGP Medical Advisor Aboriginal and Torres

Strait Islander Health

Writer of Wonky Health

What is a health system for?

• To treat the sick?

• To keep people healthy?

• To keep people in work?

• Available to all?

• Available to those who need it?

• Available to those who can afford it?

• Available to our mates?

My assumptions

-all debatable (if you wish!)

• We do actually want people to be healthy

• We do actually want an effective health system that

helps people

• We do actually want to treat those who need it.

• Why not try to do what works!

Providing medical services

Younger

More children,

more one parent

families

Renting/Dept

Housing

Less time in

formal education

More

unemployment,

more unskilled

labour

Low income

More disability

Consultations in ACCHO and GP

• Younger patients

• Longer consultations

• More health care providers involved

• More problems managed each consultation

Larkins SL, Geia LK, Panaretto KS. Consultations in general practice and at an Aboriginal

community controlled health service: do they differ? Rural and remote health. 2006;6(3).

Thomas DP, Heller RF, Hunt JM. Clinical consultations in an Aboriginal community-controlled health service:

a comparison with general practice. Australian and New Zealand Journal of Public Health.

1998;22(1):86-91.

Access

• 26% of Aboriginal people report difficulty accessing

health care

Why?

Medical Workforce Survey 2012

Health reform!

• Telehealth?

• PCEHR?

• Opening hours?

• Apps?

• New medicines?

What works for you is not what works!

• People on low income less likely to take preventive

health advice

– This is because of extrinsic factors, not choice.

• People (especially men) on low incomes less likely

to use computers to find health information.

• Health checks attract the worried well, not those

who need health checks.

Breaking down the barriers?Cultural barriers to health care for Aboriginal and Torres Strait

Islanders in Mount Isa, Kristin E. McBain-Rigg and Craig

Veitch, The Australian journal of rural health 19, no. 2 (April

2011

Interviews with community and

health professionals in Mt Isa

about barriers to care for

Aboriginal people.

What do you think they found?

“Conclusions: For Aboriginal patients the focus on

interpersonal relationships between themselves and

health practitioners is paramount. Creating comforting

physical environments and systems that are easier to

navigate do assist in overcoming cultural barriers, but are

often seen as little more than token gestures if trusting

interpersonal relationships are not formed between

patient and practitioner.”

Health is...

a state of complete physical, mental and social

wellbeing, and not merely the absence of disease

or infirmity.

not just the physical well-being of an individual but

refers to the social, emotional and cultural well-

being of the whole Community in which each

individual is able to achieve their full potential as

a human being thereby bringing about the total

well-being of their Community. It is a whole of life

view and includes the cyclical concept of life-

death-life

A health system?

Or a sickness system?