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Aboriginal Health Services (Question No. 14)

Question
Rachel Siewert 23 Nov 2010

Senator Siewert asked the Minister representing the Minister for Health and Ageing, upon notice, on 28 September 2010:

(1)    Considering there is a $3.73 gap between what is paid for supply to a non-Indigenous client at an Approved Pharmacy ($6.42) and the amount paid for the same item to be supplied to a remote Aboriginal Health Service client ($2.69), what has been done to pay for the cost of dispensing Pharmaceutical Benefits Scheme (PBS) medicines at Aboriginal Health Services.
(2)    (a) How much was allocated to the ‘Support Allowance’ being paid by the PBS to pharmacies supplying PBS medicines to remote Aboriginal Health Services using the section 100 (National Health Act 1953) special arrangements over the 5 year duration of the Fourth Community Pharmacy Agreement; and (b) how was this distributed between the states and territories.
(3)    Can the payments made to individual Aboriginal Health Services be identified; if not, why not, considering payments made to Approved Pharmacies by Medicare Australia are based on work reports submitted by those pharmacies.
(4)    Are statistics for drug usage available under the section 100 arrangements; if not, why not.
(5)    Why, when in some places 30 per cent of the clients of Aboriginal Medical Services are non-Aboriginal, are these clients not allowed to be included in the statistics for the service or funding applications.
(6)    Why are Aboriginal Medical Services in Geraldton, Perth and Bunbury (i.e. under the 26th parallel) not included in section 100 arrangements.
(7)    Why are Geraldton Aboriginal Medical Service doctors not fully funded when all doctors in Kimberley-based Aboriginal Medical Services are.

Senator Ludwig—The Minister for Health and Ageing has provided the following answer to the honourable senator’s question:

(1)    Pharmacists are paid a lower handling fee for each Pharmaceutical Benefits Scheme (PBS) medicine supplied to remote area Aboriginal health services (AHS) than the dispensing fee they would receive under the PBS for dispensing a prescription at the pharmacy, as medicines are supplied to Aboriginal health services by pharmacists in bulk, rather than for individual patients. However, additional allowances are available to pharmacists under the Community Pharmacy Agreement to support visits by pharmacists to these remote area Aboriginal health services to assist them in managing medicines for their patients. The quantum of these allowances is dependent on the size of the health service, number of outstation clinics, and travel costs.

(2)    (a) Expenditure under the Fourth Community Pharmacy Agreement (2005-2010) for the section 100 Pharmacist Support Allowance program was $6.78m. (b) A breakdown by state and territory is not available. While the allowance payments are made to specific pharmacies, which can be described by their state or territory location, each pharmacy may provide support services under the program to a number of Aboriginal health services, located in different states. In addition, some Aboriginal health services, particularly in Central Australia, provide healthcare services to clinics across at least two state/territory borders.
(3)    Payments for the allowances are made to pharmacies, not AHS. While it is possible to calculate the payments made to a pharmacy for services provided to an individual AHS, these details are not published given their commercial-in-confidence nature.

(4)    Yes. However, this information is not publicly available as it may identify individual patients (where an AHS has few patients), and reveal revenue information for individual pharmacies. Applications to access this data are assessed by the Department of Health and Ageing. Release of this information requires compliance with the National Health Act 1953 and the Privacy Act 1988, dealing with third party and privacy information.

(5)    The Office for Aboriginal and Torres Strait Islander Health (OATSIH) includes all clients of OATSIH funded services for service statistics, such as for reporting in the OATSIH Services Reporting questionnaire, and also reports by Indigenous status. For example, in 2008-09, 191 OATSIH funded Indigenous primary health care services provided 2.1 million episodes of primary health care and of these, 82% were provided to Aboriginal or Torres Strait Islander clients, 12% were provided to Non-Indigenous clients, and for the remaining 5% the Indigenous status of the clients was unknown. As some individuals may have been clients at more than one service, this count may overstate the total number of clients for all services.

(6)    The Remote Aboriginal Health Service Program is a special arrangement under section 100 of the National Health Act 1953. The eligibility criteria include the following criterion:
- The clinic, or other health care facility, operated by the AHS from which pharmaceuticals are supplied to patients must be in a remote zone as defined in the Rural, Remote and Metropolitan Areas Classification 1991 Census Edition Geraldton, Perth and Bunbury are not eligible to be included in the section 100 arrangements as they are not located in a designated remote area. Perth is located in zone 1 (Major Cities); and Bunbury and Geraldton are located in zone 4 (Inner Regional). However, Aboriginal Health Services operating clinics in a remote area (zone 6 or zone 7) may be approved to provide services through this program. This approval would only apply to the clinic located in the remote area. The Aboriginal Health Service in Geraldton has such an approval.

(7) The assertion that all doctors in Kimberley-based Aboriginal Medical Services are fully funded is not correct. The funding arrangements for Aboriginal Medical Services (or Aboriginal Community Controlled Health Organisations) in the Kimberley are the same as those for all other Aboriginal Medical Services, in that funding from OATSIH is a broad based contribution to the overall cost of providing a comprehensive primary health care service. OATSIH funding is not provided for the employment of a specific number of a specific type of employee. This applies in equal measure to clinical staff such as Doctors, Nurses and Aboriginal Health Workers and administration staff such as receptionists and bookkeepers.

Doctors salaries are the responsibility of the Board of the Aboriginal Community Controlled Health Organisation and sources of funding also include the West Australian State Government and Australian Government programs such as Medicare, and where eligible, the Practice Incentives Program and the General Practice Immunisation Incentives Scheme.

Aboriginal Community Controlled Health Organisations can also be flexible in the use of additional Medicare income to pay General Practitioner (GP) salaries. For example, allowing doctors to retain a proportion of the Medicare income they generate in addition to a base salary. This may also encourage GPs to bill Medicare for more of the services they provide.

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