Aboriginal and Torres Strait Islander people and primary health care: patterns of service use, preferences, and access to services 2024

Because primary health care encompasses such a wide range of types of services and service providers, estimating its use is quite complex. For example, at the national level, primary health care use could be measured by:

• the number of people and/or percentage of the population who used any/a specific primary health care service in a defined time period. For example, this could be the number of people who saw a GP in the past 12 months, who saw a dentist in the past 24 months, or who received an influenza vaccination in the past 12 months
• the number and types of primary health care services provided within a specified period, which provides a systems-level perspective. For example, this could include the number of Aboriginal and Torres Strait Islander specific health checks (health check) completed in the past 12 months or the number of occasions of service provided by GPs in the past 12 months   
• the frequency of service use among individuals/groups, such as the number of times an individual used a particular type of primary health care service in a defined period (such as the number of times a person visited a GP in the past 12 months).

All of these measures could then be further disaggregated by other key factors, such as location (remoteness), populations of interest (young children, older people, those with chronic diseases), types of services delivered (immunisations, health checks, chronic disease management visits), or types of organisations providing the service (mainstream GPs, community clinics, Aboriginal and Torres Strait Islander PHCOs).

In practice, reporting on these measures is difficult because all require counts of services used/provided by type, date, client characteristics, and organisation characteristics. Ideally, data would also be available on the reasons why a person sought care (not just the services provided to the person) and on the number of people who needed care but were unable to obtain it.

Currently, however, there is no single national data source that includes all these aspects and can provide yearly estimates. Rather, there are 3 main national sources of data on primary care use among Aboriginal and Torres Strait Islander people (Box 1.1), each with their strengths and weaknesses.^{[1 2]}

MBS data

The advantages of the national MBS data are that they are regularly updated, available at unit record level, and provide some information on the type of service that had been provided (through item numbers). There are some item numbers (such as for Aboriginal and Torres Strait Islander health checks) that can only be claimed for services provided to Aboriginal and Torres Strait Islander people. However, there are issues with using MBS data as well:

• Although item numbers provide information on the type of service/type of provider (such as non-referred GP attendance), there are no data available on the reason for the visit or advice provided.
• For item numbers that are not Aboriginal and Torres Strait Islander-specific, the proportion of claims by Aboriginal and Torres Strait Islander people need to be estimated using the Voluntary Indigenous Identifier (VII), which was introduced into the Medicare database from November 2002. Not all Aboriginal and Torres Strait Islander people self-identify, however, and so the MBS data for Aboriginal and Torres Strait Islander people are adjusted for under-identification (for example, they are modelled and should be interpreted with caution).

Estimates generated by the adjustment methodology for a given period will vary according to the point in time at which they are calculated, as the adjustment factors are updated regularly to account for the ongoing change in the population coverage of the VII sample. The most recently published VII adjusted data are for 2021–22 (Productivity Commission 2024).

Even with the adjustment factors, MBS data do not give a comprehensive picture of actual service delivery for Aboriginal and Torres Strait Islander people, as some service delivery (particularly in remote areas) is not part of these systems. For example, MBS data do not include services provided in the public health system or under other arrangements that do not attract an MBS claim (for example, some Aboriginal Medical Services and state/territory health services).

OSR data

The strengths of the OSR data are that these are robust, collected yearly, and contain data on organisational characteristics as well as numbers and types of services delivered (to Aboriginal and Torres Strait Islander and non-Indigenous clients).

However, the data are available only at aggregate level, nor do they include any information on services provided at mainstream GPs or other mainstream primary health centres; further, the number of organisations reporting varies slightly each year (for more information, see AIHW 2024a). There are also a small number of ACCHOs who do not receive IAHP‑funding and do not report to the OSR.

Because Aboriginal and Torres Strait Islander clients can attend more than one Aboriginal and Torres Strait Islander PHCO in a year, they will be counted as a client at each organisation they attend (so the total number of Aboriginal and Torres Strait Islander clients in a year may be higher than the number of Aboriginal and Torres Strait Islander individuals who used these services).

NATSIHS surveys

The NATSIHS surveys have the advantage of collecting detailed information from Aboriginal and Torres Strait Islander people on a range of topics, including social and cultural determinants, the need for primary health care, preferences, usage, and unmet needs, with the data available at unit record level and results able to be adjusted to the national level.

The downsides of the NATSIHS surveys primarily relate to the frequency of data collection and comparability with previous versions. Data are collected every 6 to 7 years; hence, while they can provide information on overall time trends for selected items that are collected consistently, they are unable to provide yearly data. There is also a lag between when the data are collected and when they are released.

Notes:

1. Data on use of antenatal care are part of the National Perinatal Data Collection but have not been included as their focus is only on a subsection of the population and one type of service.
2. The Bettering the Evaluation And Care of Health (BEACH) survey (now ceased) collected information on consultations with GPs, including GP and patient characteristics, patient reasons for the visit, problems managed and treatments provided. The survey was conducted annually between 1998 and 2016. Information was collected from a random sample of around 1,000 GPs from across Australia each year. Each participating GP provided details of 100 consecutive consultations.
3. The National Key Performance Indicators collection (nKPIs) also includes data collected from IAHP-funded organisations, but its focus is on clinical indicators collected for continuous quality improvement; it includes only Aboriginal and Torres Strait Islander regular clients (those who have had at least 3 occasions of service at an organisation within the past 2 years).
4. Previous versions have been known by different names. The first collection was the 1994 National Aboriginal and Torres Strait Islander Survey (NATSIS). The subject matter from the 1994 survey was later divided into 2 separate surveys – the National Aboriginal and Torres Strait Islander Social Survey (NATSISS, which included some health-related questions, and was collected in 2002, 2008 and 2014–15, which was the final collection) and health surveys, which include the 2004–05 NATSIHS, the 2012–13 Australian Aboriginal and Torres Strait Islander Health Survey, and a recently completed NATSIHS collection which is expected to be released in late 2024.