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Dr Tim Senior delivered the presentation at the 2014 Future of Medicare Conference. The Future of Medicare Conference was a timely event as the Abbott government debates a full over haul of the Australian healthcare system. This conference presented a chance for government representatives, regulators, health care providers in the public and private sector, educators and private investors to come together and debate the proposed changes to Medicare as well as discuss the best practice methods of implementing new measures and frameworks. For more information about the event, please visit: http://bit.ly/FutureofMedicare2014
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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?
