Match between preferences and usual source
Of the 390,600 people who preferred an AMS/CC, 248,000 (64%) reported one as their usual source of care (Table 4.4), meaning that 142,200 Aboriginal and Torres Strait Islander people did not use an AMS/CC even though that was their preferred source. Nearly 30% used mainstream GPs and another 5.7% reported that they had no usual source of care.
Nearly all Aboriginal and Torres Strait Islander people who expressed a preference for a mainstream GP had one as their usual source of care (88%) – fewer than 3% used an AMS/CC.
Table 4.4: Preferred source of care among Aboriginal and Torres Strait Islander people, by usual source of care, 2018–19
Unmet need for an AMS/CC
The percentage distribution of who was able and unable to use an AMS/CC by the independent variables highlights differences in the likelihood of being able to use the preferred choice (Appendix 2, Table A2.15), but it is also important to look at the numbers of Aboriginal and Torres Strait Islander people who had an unmet need for an AMS/CC, particularly those from more vulnerable groups.
The findings indicate that among those who preferred an AMS/CC but did not have one as their usual source were around:
- 87,000 people with a long-term and ongoing health condition
- 56,000 people with disability
- 30,000 adults with high/very high levels of psychological distress
- 24,000 adults who had experienced unfair treatment over the previous 12 months.
There were also considerable geographic variations in unmet need (which are a combination of both the distribution of where Aboriginal and Torres Strait Islander people live and where services are located, as discussed in Chapter 3). The highest numbers of Aboriginal and Torres Strait Islander people with an unmet need for an AMS/CC were:
- 68,000 people in Major cities and 42,000 people in Inner regional areas
- 57,000 people in New South Wales and 39,000 people in Queensland
- 65,000 people in areas with the lowest SEIFA quintiles and 57,000 in the next 2 quintiles (noting that the proportions of people in these areas who used an AMS/CC is higher than for those in more advantaged areas).
The impact of having an AMS/CC in the local area is highlighted in Table 4.5, with 91% of those with only an AMS/CC in their area and 72% of those in areas with both an AMS/CC and a mainstream GP using an AMS/CC as their usual source.
Primary care in local area | AMC/CC as usual source | Other service/none | Total |
|---|---|---|---|
AMS only | 80,423 (90.5%) | 8,445 (9.5%) | 88,868 (100%) |
Both AMS/CC and mainstream GP | 162,547 (72.1%) | 63,010 (27.9%) | 225,557 (100%) |
Mainstream GP only | 3,769 (5.2%) | 68,371 (94.8%) | 72,140 (100%) |
Neither | 1,680 (44.5%) | 2,094 (55.5%) | 3,774 (100%) |
Total | 248,419 (63.6%) | 141,920 (36.4%) | 390,339 (100%) |
Source: AIHW analysis of 2018–19 NATSIHS (ABS 2019) using DataLab.
To examine the impact of availability on who had an AMS/CC as their usual source of care in the context of the other independent variables, we ran a series of multivariate logistic regressions on those aged 18 and over,[1] using a similar approach to that used in modelling preference. The results (odds ratios) from the 4 models are presented in Table 4.6.
Table 4.6: Logistic regression results (odds ratios) and level of statistical significance, Aboriginal and Torres Strait Islander people able to use an AMS/CC (compared with any other service)
The results by domain show that, holding other variables constant:
Location and demographic variables
Only the remoteness categories are statistically significant (even after service availability is added), with those in every remoteness category at least 2 times as likely to have an AMS/CC as their usual source compared with those in Major cities.
Socioeconomic and social capital
Those who would be able to raise $2,000 in an emergency were 0.6 times as likely to use an AMS/CC as those who would not be able to raise the funds (holding other variables constant), while those not in the labour force were 2.2 times as likely to use an AMS/CC as those who were employed.
Cultural identify and experiences of unfair treatment
Those who did not identify with any tribe, clan or language group were 0.6 times as likely to use an AMS/CC as those who did identify; a similar pattern is seen for those who were not very/not at all satisfied with their own knowledge of culture (odds ratio of 0.6 compared with those who were satisfied/very satisfied).
Health and disability
None of the included health and disability variables were statistically significant (except those whose level of psychological distress was unknown), but this was included as a control variable).
Services available in local areas
By far the strongest predictor of being able to use an AMS/CC when a person preferred one was having one in a person’s local area. Those who had only an AMS/CC in their area were 77 times as likely to be able to use one as those without one, and those who had both an AMS/CC and a mainstream GP in their area were 24 times as likely to have an AMS/CC as their usual source.
This finding again highlights the importance of the local service environment in supporting Aboriginal and Torres Strait Islander people’s preferences for type of health care. The next chapter looks at the use (and non-use) of primary health care.
Notes:
- Cross-tabulations of the included variables by the outcome variable (used an AMS/CC versus used any other source/had no source) are available in Appendix 2, tables A.16 to A2.19, organised by domain.