Ideas@TheCentre
Latest Indigenous health scheme shows policymakers are still in ‘la la land’
Chronic diseases, in particular cardiovascular disease, are the biggest single killers of Indigenous people. But the government’s plan to tackle chronic diseases amongst the Aboriginal population owes more to wishful thinking than any evidence based policy.
In its latest Portfolio Budget statements, the Commonwealth Department of Health and Ageing provided a graph that estimated Indigenous Chronic Diseases Related Mortality Rates. Despite the number of deaths per 100,000 increasing from around 800 in 1996 to nearly 1,000 in 2009, the government estimates that a sharp break in trend will occur over the next three years. By 2030, the government optimistically predicts that deaths from chronic disease will be as low as 200 per 100,000 Aboriginal and Torres Strait Islanders.
Perhaps, they mistakenly believe that the government’s incentive plan announced last week will bring about this miraculous transformation in death rates. Under the scheme, general practices and Aboriginal health services will receive a one-off payment of $1,000 for signing on to the scheme.
After that, they will receive a $250 payment for each Indigenous patient over 15 with a chronic disease who agrees to sign up to the practice.
As the agreement expires at the end of each calendar year, the practice can earn another $250 per patient by re-signing them.
The practice receives a further $250 annual payment for each of these patients treated in accordance with a target level of care, which is expected to involve the doctor ensuring patients receive effective follow-up treatments.
The scheme is costing $28 million over four years, including $4.7 million this financial year. It comes on the back of last year’s commitment by the Rudd government of $805 million to tackle chronic diseases amongst Aboriginal and Torres Strait Islanders.
Putting aside the obvious concern about paying doctors’ incentives for doing something they should be doing anyway, this scheme is destined to fail.
In areas where Indigenous deaths from chronic diseases are highest, such as remote and very remote locations, there are hardly any doctors. The few doctors employed by Aboriginal medical services in these areas tend to be overseas trained doctors who are not accredited by the Royal Australian College of GPs and, therefore, ineligible for any incentive payments.
Unless the government is planning on shipping in more doctors to remote areas, it is difficult to see how these incentives payments will make any difference to those Aboriginal and Torres Strait Islanders living in squalid settlements in outback Australia.
Sara Hudson is a Policy Analyst with the Indigenous Affairs Research Program at CIS and author of Closing the Accountability Gap: The First Step towards Better Indigenous Health.
