Access to appropriate, high-quality and timely health care throughout life is essential for improving health outcomes for Aboriginal and Torres Strait Islander people (Indigenous Australians). Some aspects of health system performance for Indigenous Australians have improved the last decade. Barriers affecting their access, however, remain, as observed in their disparities in their level of access compared with non-Indigenous Australians.
This page presents measures of health system performance for Indigenous Australians drawn from the Aboriginal and Torres Strait Islander Health Performance Framework (Indigenous HPF).
The Indigenous HPF monitors progress against 68 measures organised under 3 tiers: health status and outcomes; determinants of health; and health system performance.
The Indigenous HPF Tier 3 - Health system performance includes 22 measures organised into 6 domains relating to health system effectiveness, responsiveness, accessibility, continuity, capability, and sustainability (Table 1).
Table 1: Indigenous HPF Tier 3 measures of health system performance for Indigenous Australians
|Effective, appropriate, efficient
Effective – the care, intervention or action achieves the desired outcome.
Appropriate – the care, intervention or action is relevant to the client’s needs and is based on established standards.
Efficient – the desired results are achieved with the most cost effective use of resources.
Antenatal care (3.01)
Health promotion (3.03)
Early detection and early treatment (3.04)
Chronic disease management (3.05)
Access to hospital procedures (3.06)
Selected potentially preventable hospital admissions (3.07)
Cultural competency (3.08)
||The service provides respect for persons and is client oriented, including respect for dignity, confidentiality, participation in choices, promptness, quality of amenities, access to social support networks, and choice of provider.
Discharge against medical advice (3.09)
Access to mental health services (3.10)
Access to alcohol and drug services (3.11)
Aboriginal and Torres Strait Islander people in the health workforce (3.12)
Competent governance (3.13)
||Ability of people to obtain health care at the right place and right time irrespective of income, cultural background or physical location.
Access to services compared with need (3.14)
Access to prescription medicines (3.15)
Access to after-hours primary health care (3.16)
||The ability to provide uninterrupted, coordinated care or service across programs, practitioners, organisations and levels over time.
Regular general practitioner or health service (3.17)
Care planning for chronic diseases (3.18)
||An individual or service’s capacity to provide a health service based on skills and knowledge.
Aboriginal and Torres Strait Islander people training for health-related disciplines (3.20)
||System’s or organisations’ capacity to provide infrastructure such as workforce, facilities and equipment, and be innovative and respond to emerging needs (research, monitoring).
Expenditure on Aboriginal and Torres Strait Islander health compared to need (3.21)
Recruitment and retention of staff (3.22)
It is important, however, to remember that health outcomes are very much affected by factors outside the health system. For more information on these factors, see Determinants of health for Indigenous Australians and Indigenous health and wellbeing.
Measures of the performance of the health system for Indigenous Australians drawn from the Indigenous HPF show mixed results over the most recent decade, with improvements seen in some measures but not all.
Improvements in health system performance for Indigenous Australians over the last decade include:
- increases in the number of services providing primary health care to Indigenous Australians
- an increase in Indigenous women accessing antenatal care in their first trimester of pregnancy
- increased immunisation rates for Indigenous children (with the vast majority being fully immunised at 5 years)
- increases in the rates of Indigenous health checks and use of general practitioner (GP) management plans for chronic diseases
- increased access to hospital procedures, however, Indigenous Australians are less likely than non-Indigenous Australians to receive a medical or surgical procedure (Table 2).
- ✔ = improved; ✘ = not improved; ≈ = little or no change.
- Trend based on analysis of change over time for the relevant time period. These periods vary by measure. See Indigenous HPF for detail. Trends may differ from that presented in Chapter 3 ‘Changes in Aboriginal and Torres Strait Islander people's use of health services in the early part of the COVID-19 pandemic’ in Australia’s health 2022: data insights because of differing time periods and type of data presented.
Areas of health system performance that have worsened for Indigenous Australians over the most recent decade include increases in the rate of preventable hospitalisations and in the rate of people taking their own leave from hospital before completing treatment.
Barriers to accessing health services for Indigenous Australians include services not being available in their area (especially for those living in remote areas), services being too far away and they do not have transport, cost, waiting times, and the availability of culturally safe and responsive health services.
A culturally safe and responsive health system
Improving the cultural safety and cultural responsiveness of the health system can improve access to, and the quality of, health care for Indigenous Australians. A culturally safe health system is one that respects Indigenous cultural values, strengths and differences, and addresses racism and inequity. It also requires health professionals and health services to be culturally responsive, to take action to overcome racism and power imbalances and to have active engagement with Indigenous clients/patients to ensure that the system meets their needs (Coalition of Peaks 2020; Dudgeon et al. 2010; IAHA 2019).
To measure progress in achieving cultural safety in the Australian health system, the AIHW has developed the Cultural safety in health care for Indigenous Australians: monitoring framework. For the purposes of this framework, cultural safety is defined with reference to the experiences of Indigenous health care users, of the care they are given, and their ability to access services and to raise concerns.
Lockdowns, other restrictions and changes to the health system as a result of COVID-19 affected the need for, access to, and use of a broad range of health services by Indigenous Australians. For more information, see 'Chapter 3 Changes in Aboriginal and Torres Strait Islander people's use of health services in the early part of the COVID-19 pandemic’ in Australia’s health 2022: data insights, 'Chapter 1 The impact of a new disease: COVID-19 during 2020, 2021 and into 2022’ in Australia’s health 2022: data insights, and Aboriginal and Torres Strait Islander specific primary health care: results from the nKPI and OSR collections: impact of COVID-19.
For detailed information on the performance of the health system for Indigenous Australians, see the AIHW’s and the National Indigenous Australians Agency’s (NIAA’s) Aboriginal and Torres Strait Islander Health Performance Framework and linked reports.
For more information on Indigenous Australians’ use of health services, see also:
AIHW (Australian Institute of Health and Welfare) (2021) Cultural safety in health care for Indigenous Australians: monitoring framework, AIHW, Australian Government, accessed 4 April 2022.
AIHW (2022a) Aboriginal and Torres Strait Islander Health Performance Framework, AIHW, Australian Government, accessed 4 April 2022.
AIHW (2022b) Aboriginal and Torres Strait Islander specific primary health care: results from the nKPI and OSR collections, AIHW, Australian Government, accessed 4 April 2022.
Coalition of Peaks (2020) National Agreement on Closing the Gap, Australian Government, accessed 4 April 2022.
Dudgeon P, Walker R, Scrine C, Shepherd CCJ, Calma T and Ring IT (2014) Effective strategies to strengthen the mental health and wellbeing of Aboriginal and Torres Strait Islander people, AIHW and Australian Institute of Family Studies (AIFS), Australian Government, Closing the Gap Clearinghouse, accessed 4 April 2022.
Dudgeon P, Wright M and Coffin J (2010) ‘Talking it and walking it: cultural competence’, Journal of Australian Indigenous Issues, 13:29–44.
IAHA (Indigenous Allied Health Australia) (2019) Cultural responsiveness in action: an IAHA Framework, IAHA, accessed 4 April 2022.