Access to health services

1 in 13

(7.6%) people aged under 65 with disability delay or do not see a GP when needed because of cost.

1 in 4

(24%) people aged 15–64 with disability wait longer than they feel acceptable to get an appointment with a GP.

1 in 2

(47%) people aged 5–64 with disability who need health care assistance only receive informal assistance.

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Introduction

Like everyone, people with disability have health-care needs, access health services to meet them, and have varying health-related experiences. They use a range of mainstream health services, such as GPs, medical specialists, dentists and hospitals. Their care may require coordination between different health professionals.

People with disability may also rely on informal care, such as that provided by family and friends, to meet or supplement their health-care needs.

Survey of Disability, Ageing and Carers

Data in this section are largely sourced from the Australian Bureau of Statistics’ (ABS) 2018 Survey of Disability, Ageing and Carers (SDAC). The SDAC is the most detailed and comprehensive source of disability prevalence in Australia.

The SDAC considers that a person has disability if they have at least 1 of a list of limitations, restrictions or impairments, which has lasted, or is likely to last, for at least 6 months and restricts everyday activities.

The limitations are grouped into 10 activities associated with daily living—self-care, mobility, communication, cognitive or emotional tasks, health care, reading or writing tasks, transport, household chores, property maintenance, and meal preparation. The SDAC also identifies 2 other life areas in which people may experience restriction or difficulty as a result of disability—schooling and employment.

The severity of disability is defined by if a person needs help, has difficulty, or uses aids or equipment with 3 core activities—self-care, mobility, and communication—and is grouped for mild, moderate, severe, and profound limitation. People who ‘always’ or ‘sometimes’ need help with 1 or more core activities are referred to in this section as ‘people with severe or profound disability’.

The patient experience information collected in the SDAC does not include health professionals other than GPs, medical specialists and dental professionals. Hence, it is not possible to examine from this survey whether some needs for non-hospital health services were met by other health professionals, such as nurses, pharmacists or other allied health professionals.

The patient experience information collected in the SDAC is collected from people with disability living in households. It is not collected from people without disability. Hence comparisons with people without disability cannot be directly made.


Use of mainstream health services

Table ACCESS.1 provides a snapshot of the use of mainstream health services by people with disability aged under 65 living in the community.

Table ACCESS.1: Use of selected health services by people with disability(a), 2018

Most (92%) see a GP(b)

1 in 5 (20%) see a GP for urgent medical care(b)

2 in 3 (63%) see a medical specialist(b)

Half (51%) see a dental professional(b)

1 in 4 (26%) visit a hospital emergency department(b)

1 in 5 (22%) get admitted to hospital(b)

2 in 5 (38%) see 3 or more health professionals for the same condition(b)

7 in 10 (71%) have a health professional help coordinate their care when they see 3 or more health professionals for the same condition(c)

2 in 3 (64%) who need help with health-care activities receive informal services(d)

2 in 5 (41%) who need help with health-care activities receive formal services(d)

(a) People with disability aged 64 and under living in households.

(b) For own health in the last 12 months.

(c) People who have seen 3 or more health professionals for the same condition for their own health in the last 12 months.

(d) People with disability aged 5–64 living in households including those who received both formal and informal services.

Source: ABS 2019a; see also tables ACCE1, ACCE2, ACCE25, ACCE26, ACCE29 and ACCE30.

How does the use of mainstream health services by people with disability compare with people without disability?

The patient experience information in the SDAC is only collected from persons with disability and primary carers (living in households). It is not therefore possible to compare with people without disability. However, AIHW analysis of self-reported information from the ABS’ National Health Survey 2014–15, which uses the ABS’ Short Disability Module, suggests that people with disability aged under 65 have higher rates of use of:

  • GPs (93% compared with 82% of those without disability)
  • medical specialists (58% compared with 26%)
  • hospital emergency departments (20% compared with 10%) (ABS 2016a).

Use of Medicare Benefits Schedule services

Without data linkage it is not possible to examine in detail how people with disability use health services, with the exception of self-reported survey data (such as that presented in this section). This is because health data collections generally have no ‘flag’ to identify the disability status of service recipients or patients.

To highlight how linked data can fill information gaps, this box presents data from the ABS’ 2011 Multi-Agency Data Integration Project (MADIP) data asset.

The 2011 MADIP includes:

  • de-identified information about everyone who participated in the Census of Population and Housing on 9 August 2011 and who had an active Medicare enrolment on that date
  • some information about the services they received in 2011 under the Medicare Benefits Schedule (MBS)
  • information from the 2011 Census of Population and Housing, Personal Income Tax data for tax returns for 2010–11
  • social security and related information to identify if income support payments were received in September 2011.

For more information on MADIP, see ABS MADIP.

In 2011, compared with people who received no income support, people who received the Disability Support Pension (DSP) were:

  • more likely to be frequent users of MBS services—more than one-third (36%) used 30 or more MBS services, compared with 8% (Figure ACCESS.1)
  • more likely to have regular GP visits—more than half (52%) had more than 6 un-referred attendances at a GP, compared with 17%
  • more likely to have no out-of-pocket expenses—almost half (49%) had no out-of-pocket costs for all MBS services compared with 43%
  • less likely to have out-of-pocket expenses of $100 or more—3% were $100 or more out of pocket for unreferred GP visits, compared with 11%, and 19% were more than $100 out of pocket for all MBS services compared with 30%.

Figure ACCESS.1: Number of MBS services used, by income support, age group and sex, 2011

Chart showing the proportion of people using 9 categories of number of Medicare Benefits Schedule (MBS) services in 2011. The reader can select to display the chart by whether the person receives Disability Support Pension (DSP) or no income support, by sex, and by age group in 10-year age brackets from 15–24 to 55–64, including all ages. The chart shows women on DSP aged 55–64 are more likely (48%) to access 30 or more MBS services per year than men on DSP in the same age group (38%).

Medicare Benefits Schedule

MBS services can include, but are not limited to, GP and medical specialist consultations, pathology tests, diagnostic imaging and optometry services. They do not include public hospital services, almost all dental care, and many allied health services.

Unreferred attendances at a GP are a sub-category of the broad grouping ‘all MBS services’.


Difficulties accessing health services

Service accessibility depends on many factors. Some people with disability experience difficulties in accessing health services, barriers include:

  • unacceptable or lengthy waiting times
  • cost
  • inaccessibility of buildings
  • discrimination by health professionals.

They may also experience issues caused by lack of communication between the health professionals treating them.

Table ACCESS.2 provides a snapshot of difficulties accessing health services for people with a disability aged under 65 living in the community.

Table ACCESS.2: Difficulties accessing health services for people with disability(a), 2018

1 in 4 (24%), who see a GP, wait longer than they feel is acceptable to get an appointment(b)(c)

3 in 10 (29%) wait 1 or more days after making an appointment to see a GP for urgent medical care(b)

1 in 13 (7.6%), who need to see a GP, delay or do not go because of cost(b)

1 in 3 (31%), who see a medical specialist, wait longer than they feel is acceptable to get the appointment(b)(c)

1 in 22 (4.6%), who need to see a medical specialist, do not go mainly because of cost(b)

1 in 8 (13%), who need to see a dental professional, are placed on a public dental waiting list(b)

7 in 10 (70%), who have been on a public dental waiting list(b), wait 1 month to more than 1 year before receiving dental care

3 in 10 (28%), who need to see a dental professional, delay or do not go because of cost(b)

1 in 28 (3.6%), who need to go to hospital, delay or do not go because of cost(b)

1 in 8 (12%) feel a GP could have provided care for their most recent visit to a hospital emergency department(b)

1 in 5 (21%) who see 3 or more health professionals for the same health condition report issues caused by lack of communication between health professionals(b)

1 in 29 (3.5%) experience discrimination by health staff (GP, nurse, hospital staff)(b)(c)

1 in 8 (12%) have difficulty accessing medical facilities (GP, dentist, hospital)(b)(d)

1 in 8 (13%) who need help with health-care activities have no source of assistance (formal or informal)(e)

1 in 5 (18%) who need help with health-care activities have their need for assistance only partly met or not met at all(e)

(a) People with disability aged 64 and under living in households.

(b) In the last 12 months.

(c) People with disability aged 15–64 living in households.

(d) People with disability aged 5–64 living in households who need assistance or have difficulty with communication or mobility.

(e) People with disability aged 5–64 living in households.

Source: ABS 2019a; see also tables ACCE3, ACCE4, ACCE5, ACCE6, ACCE7, ACCE8, ACCE9, ACCE10, ACCE11, ACCE12, ACCE13, ACCE14, ACCE15, ACCE16, ACCE17, ACCE18, ACCE19, ACCE20, ACCE21, ACCE22, ACCE27, ACCE28, ACCE29, ACCE30, ACCE31, ACCE32, ACCE35, ACCE36, ACCE37 and ACCE38.

How does access to health services by people with disability compare with people without disability?

As the patient experience information in the ABS SDAC is only collected from people with disability and their carers, it is not possible to make comparisons with people without disability.

While not directly comparable, information from the ABS’ Patient Experience Survey, which looks at the use of health services by the general Australian population, suggests that people with disability are more likely to face barriers such as cost when accessing some types of health services. For example, in the last 12 months:

According to the 2018 SDAC, of people with disability aged 15–64:

  • 8.7% delay or do not see a GP when needed; and
  • 32% delay or do not see a dental professional when needed;

because of cost (ABS 2019a).

According to the 2018–19 Patient Experience Survey, of the general Australian population aged 15–64:

  • 4.1% delay or do not see a GP when needed; and
  • 20% delay or do not see a dental professional when needed;

because of cost (ABS 2019b).


Remoteness

People with disability aged under 65 living in the community in Outer regional and Remote areas are less likely than those living in Major cities to see a GP, medical specialist, or dentist (Figure ACCESS.2). But they are more likely to visit a hospital emergency department.

How is remoteness defined?

The remoteness categories used in the ABS SDAC are defined by the Australian Statistical Geography Standard Remoteness Structure (ABS 2016b). Remoteness Areas divide Australia into 5 classes of remoteness on the basis of a measure of relative access to services.

Figure ACCESS.2: Use of selected health services by people with disability, by remoteness, 2018

Column chart showing the proportion of people with disability using 4 categories of health service in 3 categories of remoteness, from Major cities to Outer regional and Remote. The chart shows people with disability living in Outer regional and Remote areas are less likely (45%) to visit dental professionals than those living in Major cities (53%).

Table ACCESS.3 provides a snapshot of use of health services by people with disability aged under 65 living in the community in Outer regional and Remote areas compared with those living in Major cities.

Table ACCESS.3: Access of health services in Major cities and Outer regional and Remote areas by people with disability(a), 2018

 

 

Outer regional and Remote

Major cities

Visit a hospital emergency department for care they feel could be provided by a GP(b)(c)

12%*

11%

Go to a hospital emergency department instead of a GP(b)(c), and time of day or day of week is the main reason

15%

11%

Wait longer than they feel acceptable for an appointment with a GP(b)(d)

34%

21%

Wait longer than 1 day to see a GP for urgent medical care(b)

36%

29%

Face difficulties caused by lack of communication between health professionals (b)(e)

32%

19%

Receive only informal assistance for health-care activities(f)

54%

45%

Have difficulty accessing medical facilities (GP, dentist or hospital)(b)(g)

13%

11%

Wait longer than they feel acceptable for an appointment with a medical specialist(b)(h)

37%

30%

Wait 6 months or more on public dental waiting list before receiving dental care(b)(i)

64%

35%

Experience discrimination from health staff (GP, nurse, hospital staff)(b)(j)

8.0%

2.7%

* Relative standard error of 25%–50% and should be used with caution.

(a) People with disability aged 64 and under living in households.

(b) In the last 12 months.

(c) For most recent visit to emergency department.

(d) People aged 15–64 who saw a GP in the last 12 months.

(e) People who saw 3 or more health professionals for the same health condition.

(f) People aged 5–64 who needed help with health-care activities.

(g) People aged 5–64 who need assistance or have difficulty with communication or mobility.

(h) People aged 15–64 who saw a medical specialist in the last 12 months.

(i) People who had been on a public dental waiting list in the last 12 months. Excluding people who are still waiting.

(j) People aged 15–64.

Source: ABS 2019a; see also tables ACCE6, ACCE8, ACCE12, ACCE18, ACCE22, ACCE24, ACCE28, ACCE30, ACCE36 and ACCE38.

The higher rate of use of hospital emergency departments for non-hospital services in Outer regional and Remote areas partly occurs within a broader context of health services supply—type, volume and geographical distribution. Data from the National Health Workforce Dataset show that the number of health professionals per 100,000 population generally decreases as remoteness increases. In 2017, the rate of medical specialists, allied health professionals and dentists decreased with remoteness (AIHW 2019).

Other factors for understanding these differences include a higher proportion of people with disability living in Outer regional and Remote areas reporting that:

  • they only receive informal assistance when they need help with health care
  • they have experienced issues caused by a lack of communication between health professionals
  • they have experienced discrimination from health staff (including GP, nurse, and hospital staff) (ABS 2019a).

This suggests that some people with disability in these areas may use a hospital emergency department as their point of contact with the health system because of the unavailability of other health services or a lack of communication or understanding about what services are available.

Figure ACCESS.3: Type of health care assistance received by people with disability, by remoteness, 2018

Column chart showing the proportion of people with disability who receive formal and informal health-care assistance by remoteness, including Major cities, Inner regional, Outer regional and Remote. The chart shows people with disability living in Outer regional and Remote areas are more likely (54%) to only receive informal health-care assistance than those living in Major cities (45%).


Level of disability

People aged under 65 with severe or profound disability living in the community are more likely than those with other disability to use health services, particularly medical specialists (Figure ACCESS.4).

This group is also more likely to:

  • see 3 or more health professionals for the same condition
  • have a health professional help coordinating their care
  • face difficulties caused by lack of communication among health professionals.

Those without severe or profound disability are slightly more likely to report cost as the reason they delay seeing or do not see a GP or dental professional.

Figure ACCESS.4: Patient experience of people with disability, by service and disability status, 2018 Bar chart showing the proportion of people against categories of use of health services. The reader can select to display the chart by 5 types of health service and by disability status. The chart shows people with severe or profound disability are more likely (24%) to see a general practitioner for urgent medical care than others with disability (18%).