Expenditure on health services for Aboriginal and Torres Strait Islander peoples is of high public interest given the considerably poorer health status of Indigenous Australians compared with non-Indigenous people and their greater need for health care.
Overall and per person health expenditures
This report shows that between 1995–96 and 2004–05 there has been little change in the per person health expenditure ratio for Indigenous compared to non-Indigenous Australians (Table 2.16).
In 2004–05, $1.17 per person was spent on Aboriginal and Torres Strait Islander health for every $1.00 spent on the health of non-Indigenous Australians. Average total health expenditure per Aboriginal and Torres Strait Islander was $4,718 compared with $4,019 per person estimated for non Indigenous Australians (Table 2.2).
Total health expenditures for Aboriginal and Torres Strait Islander peoples were estimated at $2,304 million in 2004–05 (Table 2.3), or 2.8% of national expenditures on health services, the same proportion as for 2001–02.
Public versus private services
Aboriginal and Torres Strait Islander people are high users of public hospital and community health services, and comparatively low users of medical, pharmaceutical, dental and other health services which are mostly privately provided.
Sixty-seven per cent of total health spending for Aboriginal and Torres Strait Islander peoples was through public hospital services and government community health services— almost 46% for public hospitals and 22% for community health services, including those provided by the Aboriginal Community Controlled Health Organisations. In contrast for non-Indigenous Australians around 30% of health spending is public hospital services and government community health services (Table 2.3).
Aboriginal and Torres Strait Islander peoples were comparatively low users of medical services and pharmaceuticals (Table 2.4). For the mainstream Australian Government schemes of Medicare and the Pharmaceutical Benefits Scheme (PBS) Medicare benefits paid per Indigenous person were estimated to be 45% of the non Indigenous average, and PBS expenditure was estimated at 51% of the non-Indigenous average (Tables 2.18 and A1.2). Expenditure on dental and other health practitioners was 40% of the non-Indigenous average (Table 2.4).
Health services for Aboriginal and Torres Strait Islander peoples are overwhelmingly funded by governments, with the state and territory governments and the Australian Government providing almost equal amounts. In 2004–05 the states and territories provided 48% and the Australian Government 45% of total funding, while the remaining 8% came from private sources, including out-of-pocket payments (Table 2.7). For non-Indigenous people the funding was 20% from the state and territory governments, 48% from the Australian Government, and the remaining 31% from private sources (Table 2.7).
Total per person government funded expenditures were much higher for Aboriginal and Torres Strait Islander peoples than for others—$4,356 per Indigenous person compared with $2,763 per non-Indigenous person, or 58% higher (Table 2.8). Interestingly, this level of expenditure is about the same as estimates of what is spent by governments on other Australians with similar low income levels (Table 2.19 and Figure 2.5).
Growth in expenditure
In the 6 years to 2004–05, expenditures by governments for Aboriginal and Torres Strait Islander peoples rose by 23% (taking inflation into account) (Table 2.17). The state and territory governments contributed 56% ($447 million) of the growth in expenditure while the Australian Government contributed 44% ($352 million).
Public hospitals were the largest single source of increase—$302 million. The largest proportional growth was in Australian Government grants to the Aboriginal Community Controlled Health Organisations, which grew by 83% over the six years.
Data comparability over time
Care should be taken in reviewing changes over time as the methodology for some of the estimates has changed. Accurate and consistent Indigenous identification is still a major barrier to precise estimates of Aboriginal and Torres Strait Islander use of health care. Recent work has improved estimates of the level of Indigenous underestimation in the hospital data, but further work is needed to refine estimates across the health system.