Australian Bureau of Statistics

Rate the ABS website
ABS Home > Statistics > By Release Date
ABS @ Facebook ABS @ Twitter ABS RSS ABS Email notification service
4704.0 - The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples, 2008  
Previous ISSUE Released at 11:30 AM (CANBERRA TIME) 29/04/2008   
   Page tools: Print Print Page Print all pages in this productPrint All RSS Feed RSS Bookmark and Share Search this Product  

USE OF HEALTH SERVICES

Information on the use of health services by Aboriginal and Torres Strait Islander people is available from a range of sources. This section draws on survey data from the 2004-05 NATSIHS and the survey of general practice activity, as well as administrative data from services such as alcohol and other drug treatment services, mental health services and hospitals.

The 2004-05 NATSIHS and 2004-05 NHS asked respondents about health-related actions they may have taken in the previous two weeks, and about hospital admissions in the previous 12 months. Approximately 20% of Indigenous Australians reported they had visited a doctor or specialist in the last 2 weeks, 17% had consulted with other health professionals in the last 2 weeks, while 16% had been admitted to hospital in the last 12 months (ABS 2006c).

After adjusting for differences in the age structures of the Indigenous and non-Indigenous populations, a higher proportion of Indigenous people than non-Indigenous people had taken at least one health-related action. The differences were most marked in relation to visits to casualty (rate ratio of 2.3) and other health professionals (rate ratio of 1.5). On the other hand, Indigenous Australians visited a dentist at 0.6 times the rate for non-Indigenous Australians (ABS 2006c).


Community controlled primary health services

Health services that are initiated, controlled and operated by the Indigenous community have the potential to increase the level of access to health services for Aboriginal and Torres Strait Islander people by providing holistic and culturally appropriate care. A review of the Australian Government's Aboriginal and Torres Strait Islander primary health care program (the Primary Health Care Review), completed in 2003-04, found that access to comprehensive primary health care was an essential component of action to improve health status (Dwyer et al 2004).

Aboriginal and Torres Strait Islander primary health care services offer clinical care, screening programs, and a wide range of preventative health care activities, as well as health-related and community support services. In addition, other services offered include social and emotional wellbeing support, provided by counsellors and social workers; substance use treatment and health-related community support roles, such as men's and women's support groups; transport to medical appointments; and school-based activities. The Australian Government provides funding to some 140 community controlled Aboriginal and Torres Strait Islander primary health care services. State and territory governments also provide a number of community-based Indigenous primary health care services.

A recent initiative by the Australian Government aims to improve primary health care for Aboriginal and Torres Strait Islander people that is delivered through both community controlled and other health services (see box 10.15, below).


10.15 HEALTHY FOR LIFE

Healthy for Life is an Australian Government program that aims to improve the capacity and performance of primary health care services to deliver high quality maternal and children's health services, and chronic disease care to Aboriginal and Torres Strait Islander people. The program uses population health approaches and is guided by best practice and quality improvement principles. It is funded by the Office for Aboriginal and Torres Strait Islander Health (OATSIH) of the Australian Government Department of Health and Ageing. At the end of 2007 there were 73 services participating in the program.

The collection of good quality data by Healthy for Life services is important for improving local service delivery, as well as for monitoring of national expected outcomes for the Healthy for Life program. OATSIH has developed a set of 11 essential indicators, with additional qualitative indicators, for which services are required to provide data. A web-based information system is used by services to report indicator and related data and generate reports back to services. The AIHW is responsible for storage, collation and analysis of data collected from the Healthy for Life services.


General practice

Information about the extent to which GPs are used by both Indigenous and other Australians is available from a survey of general practice activity in Australia known as the Bettering the Evaluation and Care of Health (BEACH) survey. See Chapter 7 for more information on the BEACH methodology and for data on consultations between Indigenous people and GPs for the period 2001-02 to 2005-06 (table 7.6).

Over the five-year period 2001-02 to 2005-06, only 1.5% of total consultations were with Aboriginal and Torres Strait Islander patients. This rate of consultation is low, relative to the proportion of Indigenous people in the total population (2.5% at 30 June 2006). These lower figures may be the result of the geographic distribution of GPs not reflecting that of the Indigenous population; lower use of private GP services by Indigenous people where other services such as Aboriginal primary health care services exist; Indigenous people using other services such as hospital emergency departments or pharmacists; failure by GPs to record the Indigenous status of patients; or Indigenous patients not identifying as Indigenous. Supplementary surveys in recent years (Supplementary Analysis of Nominated Data (SAND)) together with investigations of means for better ascertaining the Indigenous status of patients in the BEACH survey, have suggested ways for improving such data in the future.


Alcohol and other drug treatment services

Information on the use of alcohol and other drug treatment services by Aboriginal and Torres Strait Islander people is available from a number of sources, including the Drug and Alcohol Service Report (DASR), the Service Activity Reporting (SAR) data, and the Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS-NMDS). It should be noted that the DASR, SAR and AODTS-NMDS have different collection purposes, scope and counting rules, therefore the resulting data are not comparable.

The DASR collects information from all Australian Government-funded Aboriginal and Torres Strait Islander substance use-specific services. In 2004-05, of the estimated 27,600 clients seen by these services, 78% (21,600) identified as being of Aboriginal and/or Torres Strait Islander origin (AIHW 2006a). Common substances/drugs for which services provided treatment or assistance included alcohol use (100% of services), cannabis (95%), multiple drug use (78%), amphetamines and tobacco/nicotine (61% each).

The SAR collects information from all Australian Government-funded Aboriginal and Torres Strait Islander primary health care services. Around half of these services had treated clients for multiple drug use (53%), benzodiazepines (52%), solvents and inhalants (49%) and petrol (47%). Most services covered issues relating to alcohol use (89%), tobacco/nicotine (84%) and/or cannabis (82%) (AIHW 2006a).

The AODTS-NMDS is a nationally agreed set of common data items collected by in-scope government-funded service providers of clients of alcohol and other drug treatment services (AIHW 2006a). Reported numbers in the 2004-05 annual report on the AODTS-NMDS do not include the majority of services covered by the DASR and SAR collections, as these services are not included in the specific program under which the Australian Government currently reports AODTS-NMDS data. Data for 2004-05, the fifth year of collection, are presented here.

In 2004-05, there were 13,666 closed treatment episodes (10%) involving clients who identified as being of Aboriginal and/or Torres Strait Islander origin (table 10.16) (AIHW 2006a). A closed treatment episode refers to a period of contact between a client and a treatment agency, with defined start and end dates.

10.16 CLOSED TREATMENT EPISODES, by Indigenous status and age - 2004-05

Indigenous
Other(a)
Total
Age group (years)
no.
%
no.
%
no.
%

10-19
2 786
2.0
14 620
10.3
17 406
12.2
20-29
4 387
3.1
41 857
29.4
46 244
32.5
30-39
3 935
2.8
36 188
25.5
40 123
28.2
40-49
1 672
1.2
22 284
15.7
23 956
16.9
50-59
395
0.3
9 198
6.5
9 593
6.7
60 and over
80
0.1
3 248
2.3
3 328
2.3
Not stated
411
0.3
1 083
0.8
1 494
1.1
Total
13 666
9.6
128 478
90.4
142 144
100.0

(a) Includes closed treatment episodes for clients for whom Indigenous status was not stated (5% of episodes).
Source: AIHW 2006a


Overall, closed treatment episodes involving Aboriginal and Torres Strait Islander clients were most likely to involve alcohol (43%), cannabis (23%), heroin (12%) or amphetamines (11%) - that is, the same four principal drugs of concern as for non-Indigenous Australians - but with alcohol more likely to be nominated (43% compared with 37%) and heroin less so (12% compared with 18%).


Community mental health services

Mental health care is provided by a broad range of services and agencies including care provided by general practitioners, psychologists and medical specialists, as well as through community mental health services. Information on the use of community mental health services by Aboriginal and Torres Strait Islander people is available from the AIHW National Community Mental Health Care Database (NCMHCD). Community mental health care is defined as care which is provided by specialised public mental health services dedicated to the assessment, treatment, rehabilitation and care of non-admitted clients. This excludes specialised mental health care for admitted patients (covered in Chapter 7), support that is not provided by specialised mental health care services, care provided by non-government organisations, and residential care.

Data on the use of community mental health services by Indigenous clients in 2004-05 are presented here. There is likely to be an under-estimation of the actual number of service contacts for Indigenous clients in these data due to data quality issues. In some instances, Indigenous clients may have been reported as non-Indigenous, or they may have been represented within the service contacts with a 'not stated' Indigenous status (AIHW 2007j).

In 2004-05, around 4% of service contacts (224,213) were for clients who identified themselves as Indigenous (table 10.17). After adjusting for differences in the age structures of the Indigenous and non-Indigenous populations, the rate at which community mental health services were accessed by Aboriginal and Torres Strait Islander peoples was 507 service contacts per 1,000 population compared with 220 service contacts per 1,000 population for other Australians - a rate ratio of 2.3. The rate ratio of service contacts for Indigenous Australians and other Australians has increased from 1.4 in 2002-03 and 1.7 in 2003-04, however, this may be due to increased coverage of services and/or improved identification of Aboriginal and Torres Strait Islander clients, rather than an actual increase in the proportion of Indigenous people accessing community mental health services.

Consistent with differences in the age structures of the two populations, Indigenous Australians were more likely than other Australians to have service contacts in the younger age groups and correspondingly lower representation in the older age groups. For example, 24% of service contacts for Indigenous males were for clients aged 15-24 years compared with 17% of service contacts for other Australian males. There were more service contacts for Aboriginal and Torres Strait Islander males than for females (1.6 times) whereas the rates for other Australian males and females were similar.

10.17 COMMUNITY MENTAL HEALTH SERVICE CONTACTS, by Indigenous status, sex and age - 2004-05(a)

Indigenous
Other(b)
Total
Sex and age group (years)
no.
%
no.
%
no.
%

Males
Less than 15
12 158
8.7
223 624
8.9
235 782
8.9
15-24
32 650
23.5
416 807
16.6
449 457
17.0
25-34
53 098
38.2
661 254
26.3
714 352
26.9
35-44
27 891
20.1
517 875
20.6
545 766
20.6
45-54
8 927
6.4
327 865
13.0
336 792
12.7
55-64
3 319
2.4
165 311
6.6
168 630
6.4
65 and over
929
0.7
191 163
7.6
192 092
7.2
Total(c)
139 037
100.0
2 512 477
100.0
2 651 514
100.0
Females
Less than 15
6 284
7.4
143 567
6.5
149 851
6.5
15-24
18 963
22.3
388 419
17.5
407 382
17.7
25-34
24 910
29.3
400 826
18.0
425 736
18.5
35-44
19 460
22.9
410 706
18.5
430 166
18.7
45-54
10 446
12.3
330 475
14.9
340 921
14.8
55-64
2 169
2.6
198 289
8.9
200 458
8.7
65 and over
2 709
3.2
341 794
15.4
344 503
14.9
Total(c)
84 985
100.0
2 221 516
100.0
2 306 501
100.0
Total(c)
224 213
. .
4 884 311
. .
5 108 524
. .

. . not applicable
(a) These data should be interpreted with caution due to likely under-identification of Indigenous persons.
(b) Includes service contacts for clients for whom Indigenous status was not stated.
(c) Includes service contacts for clients for whom age or sex was not stated.
Source: AIHW 2007j



Hospital services

Hospital services are a major component of expenditure on health services for Aboriginal and Torres Strait Islander people. Although the reasons for which people are hospitalised and the procedures they may undergo in hospital are not necessarily indicative of the health of the total population, information on hospitalisations can provide some insights into the health of the population.

Hospitalisation statistics are limited to information about the conditions for which people are admitted to hospital, thereby excluding service use information regarding those who visited the emergency department but were not admitted, or had hospital outpatient clinic visits, or who made use of other health services, such as GPs and community health clinics. The number and pattern of hospital admissions can also be affected by the variation between hospitals in decisions about whether to admit patients or to treat them as non-admitted patients. Information concerning non-admitted patients is only reported in selected public hospitals and is not always available at the episode-level. Other factors, such as the availability of, and access to, other medical services, may influence hospital utilisation. For example, a rising rate of hospitalisation could mean that health status has deteriorated, or that access to hospitals has improved, or that access to GPs has decreased, or all of these.

Indigenous Australians are less likely than other Australians to undergo a procedure once admitted to hospital. It is not known which factors cause this disparity. Presentation late in the course of the illness, the presence of co-morbidities and communication difficulties are some of the suggested factors that may be involved (AHMAC 2006). Along with data on hospitalisations, this section provides information on hospital procedures recorded for Indigenous and other Australians.

Hospitalisations

Hospitalisation rates for Indigenous people are influenced by their relatively poor health status, as well as their access to hospital and other health services (AIHW 2007b). Reported hospitalisation rates in the Indigenous population are also influenced by the quality of Indigenous identification in hospital records, which varies among the states and territories (see Chapter 7, 7.9 IDENTIFICATION OF INDIGENOUS PERSONS IN HOSPITAL RECORDS for more detail).

The information presented in this section is for the six jurisdictions which have been assessed as having adequate identification of Indigenous people in hospitalisations data in 2004-05 - New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory. These six jurisdictions represent approximately 96% of the Indigenous population of Australia, however, the information presented here is not necessarily representative of the other two jurisdictions (Tasmania and the Australian Capital Territory).

In Australia, during 2005-06, there were 7.3 million hospitalisations recorded across all jurisdictions (AIHW 2007b). In the same period, around 7.0 million hospitalisations were recorded in New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory combined. Of these, 243,106 or 3.5% were hospitalisations of Indigenous people. The same patient may have been hospitalised more than once during this period. After adjusting for differences in the age structures of the Indigenous and non-Indigenous populations, Indigenous males and females were more than twice as likely to be hospitalised as other Australian males and females.

In 2005-06, in New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory combined, about 94% of hospitalisations involving Indigenous patients were recorded in public hospitals, compared with 60% of hospitalisations of other Australians. While Indigenous patients are not identified well in private hospitals compared with public hospitals, the much lower proportions of hospitalisations of Indigenous patients in private hospitals probably reflects lower attendance at private hospitals by Indigenous patients.

The most common diagnosis for both Indigenous males and females in hospitalisations data in 2005-06 was 'care involving dialysis', which is used in the treatment of chronic kidney disease. In New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory combined, hospitalisation rates for a diagnosis of care involving dialysis accounted for 41% of all hospitalisations involving Indigenous patients, and 11% of hospitalisations for other patients; rates were around 14 times as high for Indigenous Australians compared with other Australians.

Potentially preventable hospitalisations

Potentially preventable hospitalisations provide an indication of the scope for health gain through preventative care and early disease management. These are also referred to as ambulatory care-sensitive conditions and are admissions to hospital that potentially could have been prevented through the provision of appropriate non-inpatient health services. Potentially preventable hospitalisations will never be entirely eliminated, but the variation in rates between Indigenous and non-Indigenous Australians demonstrates considerable potential for strengthening the impact of non-hospital care.

Ambulatory care-sensitive conditions can be broken down into three categories:

  • vaccine-preventable conditions, including influenza, tetanus, measles, mumps, rubella, diphtheria, pertussis and polio;
  • potentially preventable acute conditions, including dehydration, gastroenteritis, kidney infection, perforated ulcer, cellulitis, pelvic inflammatory disease, ear, nose and throat infections, and dental conditions; and
  • potentially preventable chronic conditions, including diabetes, asthma, angina, hypertension, congestive heart failure and chronic obstructive pulmonary disease.

In 2005-06, in New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory combined, the rate of hospitalisations due to ambulatory care-sensitive conditions for Indigenous Australians was five times the rate for other Australians. Indigenous Australians were hospitalised for potentially preventable chronic conditions at eight times the rate of other Australians, for potentially preventable acute conditions at twice the rate, and for vaccine preventable conditions at three times the rate of other Australians (graph 10.18). Of the potentially preventable chronic conditions, diabetes complications had the highest hospitalisation rate, with the rate for Indigenous Australians being twelve times the rate for other Australians.

10.18 HOSPITALISATION RATES FOR AMBULATORY CARE SENSITIVE CONDITIONS, by Indigenous status(a) - 2005-06
Graph: 10.18 Hospitalisation rates for ambulatory care sensitive conditions, by Indigenous status, NSW, Vic., Qld, WA, SA and NT combined, 2005-06


Age-specific hospitalisation rates by Indigenous status are shown for three different scenarios (graphs 10.19, 10.20 and 10.21). The first scenario which includes all hospitalisations (including dialysis) shows rates of hospitalisations for Indigenous patients and for other patients in all age groups from 25 years onwards. When dialysis was excluded in the second scenario, the difference in hospitalisation rates between Indigenous and non-Indigenous Australians was much smaller. When hospitalisations from both dialysis and ambulatory care sensitive conditions were excluded in the third scenario, much of the difference in hospitalisation rates between Indigenous and other Australians from 25 years onwards was removed. Dialysis and ambulatory care sensitive conditions accounted for 80% of all hospitalisations of Indigenous people aged 45 years or over, compared with 28% for other Australians in this age group.

10.19 RATES FOR HOSPITALISATIONS INCLUDING DIALYSIS, by Indigenous status and age(a) - 2005-06
Graph: 10.19 Rates for hospitalisations including dialysis, by Indigenous status and age, NSW, Vic., Qld, WA, SA and NT combined, 2005-06


10.20 RATES FOR HOSPITALISATIONS EXCLUDING DIALYSIS, by Indigenous status and age(a) - 2005-06
Graph: 10.20 Rates for hospitalisations excluding dialysis, by Indigenous status and age, NSW, Vic., Qld, WA, SA and NT combined, 2005-06


10.21 HOSPITALISATIONS EXCLUDING DIALYSIS AND AMBULATORY CARE SENSITIVE CONDITIONS, by Indigenous status and age(a) - 2005-06
Graph: 10.21 Hospitalisations excluding dialysis and ambulatory care sensitive conditions, by Indigenous status and age, NSW, Vic., Qld, WA, SA and NT combined, 2005-06



Hospitalisations and procedures

Procedures are clinical interventions (surgical interventions and interventions that require specialised training or special facilities or equipment) such as X-rays and chemotherapy. One or more procedures can be reported for each hospitalisation, but many hospital admissions will not involve procedures.

Around half (48%) of all hospitalisations of Indigenous Australians (excluding dialysis hospitalisations) did not have a procedure reported. Around 16% of Indigenous hospitalisations had one procedure reported, 16% had two procedures reported, 8% had three procedures reported and 11% had four or more procedures reported (table 10.22).

While Indigenous Australians were more likely to be hospitalised than other Australians, they were less likely to undergo a procedure once admitted to hospital. Indigenous Australians were twice as likely as other Australians to have no procedures recorded and less likely than other Australians to have 1 to 9 procedures recorded. They were, however, more likely to have 10 or more procedures recorded, probably reflecting higher rates of co-morbidities and case complexity.

10.22 HOSPITALISATIONS (EXCLUDING DIAGNOSES FOR CARE INVOLVING DIALYSIS), by number of procedures - 2005-06

Number
Crude proportion
Age standardised proportion(a)
Number of procedures
Indigenous
Other
Indigenous
Indigenous
Other
Ratio(b)

0
70 474
1 276 264
48.3
38.6
20.4
1.9
1
23 940
1 282 689
16.4
18.8
20.5
0.9
2
23 762
1 764 594
16.3
16.5
28.3
0.6
3
12 352
950 506
8.5
9.2
15.2
0.6
4
6 095
410 862
4.2
4.5
6.6
0.7
5-9
7 717
516 492
5.3
5.7
8.3
0.7
10 or more
2 338
75 648
1.6
1.6
1.2
1.3
Total hospitalisations
145 875
6 244 283
100.0
. .
. .
. .
Total hospitalisations with procedure
76 204
5 000 791
52.2
55.8
80.1
0.7

. . not applicable
(a) Proportions are indirectly age standardised using the age-specific proportions of other Australians as the standard.
(b) Ratio is observed hospitalisations divided by the expected number of hospitalisations based on the age and sex-specific proportions for other Australians.
Source: AIHW National Hospital Morbidity Database


For almost all principal diagnoses, Indigenous patients were less likely than other patients to have a procedure recorded (graph 10.23). The greatest disparities between Indigenous and other Australians in the proportion of hospitalisations with a procedure reported were seen in hospitalisations for diseases of the nervous system, diseases of the respiratory system, and symptoms, signs and abnormal findings (e.g. breathing abnormalities, nausea and vomiting, fever of unknown origin).

Indigenous Australians are less likely to undergo a procedure once admitted to hospital than other Australians but it is not known which factors cause this disparity. This can include institutionalised racism (AMA 2007) which has been defined as 'systemic practices not ill-intentioned, but still discriminatory, and almost invisible to the patient provider encounter' (AHMAC 2006). Presentation late in the course of the illness, the presence of co-morbidities and communication difficulties are some of the other suggested factors that may be involved (AHMAC 2006).

10.23 HOSPITALISATIONS WITH A PROCEDURE RECORDED, by principal diagnosis and Indigenous status(a) - 2005-06
Graph: 10.23 Hospitalisations with a procedure recorded, by principal diagnosis and Indigenous status, 2005-06


Coronary procedures

A study by Coory and Walsh (2005), which followed patients admitted to Queensland hospitals for acute myocardial infarction (AMI) between 1998 and 2002, found that rates of coronary procedures among Indigenous patients were significantly lower (by 22%) than among other patients with AMI.

The AIHW report Aboriginal and Torres Strait Islander people with coronary heart disease: further perspectives on health status and treatment, outlines the disparities between Aboriginal and Torres Strait Islander people and other Australians in the health status and treatment of coronary heart disease (CHD), including the use of coronary procedures in hospital (AIHW 2006b). Among those Australians hospitalised with CHD in 2002-03, Indigenous Australians were less likely than other Australians to receive key coronary investigations and procedures, such as coronary angiography and revascularisation. This was evident across all age groups.

In 2002-03, there were 4,126 hospitalisations of Indigenous Australians with CHD as the principal diagnosis, compared with 113,109 hospitalisations of other Australians. After adjusting for differences in the age structures of the Indigenous and non-Indigenous populations, the angiography and revascularisation rates for Aboriginal and Torres Strait Islanders were 40% lower than the rate for other Australians (rate ratios of 0.6 for both). Revascularisation procedures include percutaneous coronary intervention (PCI) and coronary artery bypass grafts (CABG). Similar results were observed when PCI and CABG were analysed separately, with Indigenous Australians generally less likely to receive these procedures than other Australians across all age groups for those hospitalised for CHD. The age-adjusted procedure rate for PCI is around 40% lower than other Australians, while the age-adjusted rate for CABG is 20% lower (age standardised rate ratio of 0.6 and 0.8 respectively).

Indigenous Australians with CHD tended to be more complex cases (as measured by the number of co-morbidities). However, the complexity of cases did not explain the lower procedure rate in Indigenous Australians compared with other Australians. In 2002-03, Aboriginal and Torres Strait Islander people with CHD were less likely to undergo a coronary procedure across all levels of complexity. The largest difference in procedure rates between Indigenous Australians and other Australians occurred in the least complex groups (no or 1-2 co-morbidities present). In these groups, Indigenous Australians were just over half as likely to have had a coronary procedure.

Treatment for cancer

A study of 815 Indigenous and 810 non-Indigenous patients diagnosed with cancer in Queensland between 1997 and 2002 found that after adjustment for stage at diagnosis, treatment and co-morbidities, non-Indigenous Australians had better survival rates than Indigenous patients. Indigenous patients were less likely to have had treatment for cancer (e.g. surgery, chemotherapy, radiotherapy) and were more likely to have waited longer for surgery than non-Indigenous patients (Valery et al 2006).

A study in Western Australia of patients who had a cancer registration in the state between 1982 and 2001 found that Indigenous women were as likely as non-Indigenous women to undergo breast-conserving surgery for breast cancer, but Indigenous men were less likely than non-Indigenous men to receive radical prostatectomy for prostate cancer. Indigenous people were also less likely than non-Indigenous people to receive surgery for lung cancer (Hall et al 2004).



Previous PageNext Page

Bookmark and Share. Opens in a new window


Commonwealth of Australia 2014

Unless otherwise noted, content on this website is licensed under a Creative Commons Attribution 2.5 Australia Licence together with any terms, conditions and exclusions as set out in the website Copyright notice. For permission to do anything beyond the scope of this licence and copyright terms contact us.