Introduction
Primary health care is often the first contact a person has with the health system outside of a hospital or specialist. It encompasses a range of services that aim to keep people well physically and emotionally (promote good health) as well as to identify and manage illnesses, injuries and chronic diseases when they arise. As well as care provided by general practitioners (GPs), examples of the large range of primary health care services include nursing care, midwifery, pharmacy, dentistry, allied health care (such as physiotherapy, psychology and counselling, and speech pathology) and dental care.
High-quality primary health care can contribute to improved health and wellbeing by:
- improving health literacy and the self-management of chronic disease (providing linkages to services within and outside the health system)
- improving screening for and treatment of acute and chronic illnesses
- providing preventive care such as immunisations.
For Aboriginal and Torres Strait Islander people, culturally responsive, comprehensive, high-quality and timely primary health care throughout life that acknowledges the impact of social, cultural and historical determinants is essential to improve health outcomes (AIHW 2023a, 2023b; Dudgeon et al. 2014; Griew et al. 2008).
Aboriginal and Torres Strait Islander people can access primary health care in different settings, such as:
- private practices, which are generally funded through a combination of Medical Benefits Schedule (MBS) rebates (for eligible items/practitioners) and patient contributions (including through private health insurance)
- Aboriginal and Torres Strait Islander specific primary health care organisations (PHCOs), which receive funding from the Australian Government through the Indigenous Australians’ Health Programme (IAHP) to provide comprehensive and culturally safe care to Aboriginal and Torres Strait Islander clients. The majority of these organisations are managed by Aboriginal Community Controlled Health Organisations (ACCHOs)
- other community-based health care, which may be provided by government or non‑government organisations (NGOs), and which are often low or no-cost.
While access to some aspects of primary health care has improved over time, data show that there are still challenges, such as:
- the spatial distribution of services and providers relative to where Aboriginal and Torres Strait Islander people live
- the unmet need for a range of specific types of primary health care services (such as GPs, dentists and counsellors, among others)
- the ability of Aboriginal and Torres Strait Islander people to access their preferred type of service provider (AIHW 2023a).
To enhance access to timely and culturally relevant primary health care, it is essential to:
- understand the individual and systemic factors underpinning the patterns of primary health care use among Aboriginal and Torres Strait Islander people
- identify the groups or areas with the greatest unmet need (including for people who do not use health care at all).
Conceptually, use (or non-use) of primary health care is complex, involving need, service availability, service accessibility, preferences, and experiences with the health system which can then affect both future health and health-care behaviours (Davy et al. 2016; Levesque et al. 2013).