Health care systems for Aboriginal and Torres Strait Islander Australians require know-how to navigate, writes Karalyn Huxhagen
The burden of disease in the Aboriginal and Torres Strait Islander (ATSI) population is still too high for an advanced first world country such as Australia. The WHO has reprimanded Australia for not doing enough for our indigenous people in terms of their health priorities.
There are many programs to assist the ATSI patient to access improved health outcomes, but are these programs being accessed and used effectively?
The Closing the Gap program is one initiative developed by the Australian Government to assist the ATSI client. The Medicare website cites the patient eligibility criteria to be:
“The measure aims to benefit Aboriginal and Torres Strait Islander people of any age who present with an existing chronic disease or are at risk of chronic disease and, in the opinion of the prescriber:
- would experience setbacks in the prevention or ongoing management of chronic disease if they did not take the prescribed medicine, and
- are unlikely to adhere to their medicines regimen without assistance through the measure
“Eligible patients can be registered at either:
- general practices participating in the Indigenous Health Incentive under the Practice Incentives Programme or
- Indigenous Health Services in urban and rural settings”
The Medicare website goes on to describe the eligibility criteria for prescribers participating in this program:
- any medical practitioner working in a practice that is participating in the Indigenous Health Incentive under the Practice Incentives Programme
- any medical practitioner working in an Indigenous Health Service in rural or urban settings
- any medical specialist in any practice location provided the patient is eligible under the Closing the Gap – PBS Co-payment Measure, and has been referred by a medical practitioner working in a practice that is participating in the Indigenous Health Incentive PBS Co-payment Measure under the Practice Incentives Programme
The prescriber must annotate the prescription with CTG either electronically or hand written and this informs the pharmacist to provide CTG benefits to these clients.
As a practicing community pharmacist I often receive prescriptions for ATSI clients without the CTG notation attached. When I ask the client they tell me that have identified at the GP surgery as an ATSI client but still the system has not recognised them.
This issue occurs because to access Closing the Gap the surgery has to register the patient as belonging to that surgery. It is not as simple as the client ticking the box that says “Are you of Aboriginal or Torres Strait Islander heritage?”
If the client is registered with another GP practice then they have to ‘transfer’ to this new surgery. The GP surgery receives an Indigenous Health Incentive under the Practice Incentive Program to manage the care plans of the Aboriginal and Torres Strait Islander patients.
Medicare described this payment as:
‘The PIP Indigenous Health Incentive aims to support general practices and Indigenous health services to provide better health care for Aboriginal and Torres Strait Islander patients, including best practice management of chronic disease.
This incentive is a key part of the Council of Australian Governments (COAG) National Partnership Agreement on Closing the Gap: Tackling Indigenous Chronic Disease.’
Table 1: Payments and requirements of the PIP Indigenous Health Incentive
Activity required for payment
$1000 per practice
One-off payment to practices that agree to undertake specified activities to improve the provision of care to their Aboriginal and/or Torres Strait Islander patients with a chronic disease.
(ii) Patient registration payment
$250 per eligible patient per calendar year
A payment to practices for each Aboriginal and/or Torres Strait Islander patient aged 15 years and over who are registered with the practice for chronic disease management.
(iii) Outcomes payment—up to $250
Tier 1: $100 per eligible patient per calendar year
A payment to practices for each registered patient where a target level of care is provided by the practice in a calendar year.
Tier 2: $150 per eligible patient per calendar year
A payment to practices for providing the majority of care for a registered patient in a calendar year.
If the practice has a rural and remote and metropolitan area (RRMA) classification of 3-7 the practice is able to access an extra loading fee of between 15-50%.
There are a lot of requirements that the GP practice must meet to claim this indigenous heath pip incentive. The system as it stands does not always work for the benefit of these clients.
The ATSI client may move location due to family dynamics, work or simply as part of their normal custom. Being attached to receive benefits from one GP surgery is not always best practice for these clients.
BUT if the ATSI client is located in your pharmacy’s area and IS not transient in where they live there is enormous benefit for the whole family to be registered with the practice. There is also huge benefit for them to access one pharmacy especially if you are registered to supply benefits under the QUMAX program.
The pharmacist has a responsibility and a need to understand the dynamics of programs such as Closing the Gap, QUMAX, Indigenous Health Incentive payments. The pharmacist should be able to give support and guidance to these people whose understanding of these programs may be limited. Not all GP practices have a clear understanding of practice incentive payments and enrolment criteria.
How many times do you have to call a practice and tell them how to perform a DVA referral for accessing aids or a dietician referral for supplements for DVA clients?
The eligibility criteria for prescribers was expanded to include specialists but sadly does not include hospital prescribers. This is an issue and a shortfall in the system that needs to be addressed.
I know pharmacists are very busy people but it is our responsibility to understand these systems and provide support and advice to all of our clients who require better access to improve their health outcomes.
Karalyn Huxhagen is a community pharmacist and was 2010 Pharmaceutical Society of Australia Pharmacist of the Year. She has been named winner of the 2015 PSA Award for Quality Use of Medicines in Pain Management and is group facilitator of the Mackay Pain Support Group.