There is evidence that Australia is not meeting its obligations to Aboriginal and Torres Strait Islander peoples for their right to the “highest attainable standard” of health, required under the International Covenant on Economic, Social and Cultural Rights (ICESCR).
Poor access to primary health care for Aboriginal peoples and substantial shortfalls in government spending to address this are in violation of the ICESCR.
Aboriginal and Torres Strait Islander peoples’ share of the universal health coverage expenditure offered to all Australians is less per person than for other Australians.
The failure to monitor the provision of mainstream health services to Aboriginal peoples and inequitable distribution of health facilities and services compound these violations.
Equality in health between Indigenous and non‐Indigenous Australians is achievable, but not until the shortfall in health services expenditure for Indigenous Australians is addressed.
Paying incentives above the baseline Medicare Benefits Schedule to health services for the additional work required to meet the health needs of Aboriginal people or Torres Strait Islanders might mitigate inequalities of care, but evidence supporting this is lacking.
The proposed “Indigenous health” incentive payment to reduce Aboriginal health disadvantage, which is largely aimed at increasing the responsiveness of mainstream general practices, provides an opportunity to examine the assumptions behind this and other recent health reform bids.
Contentious implementation issues include: the ineligibility of several Aboriginal community controlled health services (ACCHSs) to receive this payment; determining Aboriginality and the potential for misappropriation of payments; the difficulty accounting for practice population diversity and patient mobility; and concerns about the benefits or otherwise to the Aboriginal community.
Evaluation of the measure will present problems: to attribute outcomes, an evaluation must disaggregate outcomes by type of service provider (general practice or ACCHS).
If these challenges are not addressed, this initiative may end up merely funding coordination of care for those Aboriginal people and Torres Strait Islanders who are already regular users of the health system.
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