Does affirmative action reduce disparities in healthcare use by Indigenous peoples? Evidence from Australia's Indigenous Practice Incentives Program

Abstract

Globally, Indigenous populations experience poorer health but use less primary healthcare than their non-Indigenous counterparts. In 2010, the Australian government introduced a targeted reform aimed at reducing these disparities. The reform reduced, or abolished prescription medicine co-payments and provided financial incentives for GPs to better manage chronic disease care for Indigenous peoples.Exploiting the framework of a natural experiment, we investigate how the reform affected these health disparities in primary and specialist healthcare utilization using longitudinal administrative data from 75,826 Australians, including 1896 Indigenous peoples, with cardiovascular disease. The differences-in-differences estimates indicate that the reform increased primary healthcare use among Indigenous peoples, including 12.9% more prescription medicines, 6.6% more GP services, and 34.0% more chronic disease services, but also reduced specialist attendances by 11.8%. Increases in primary care were larger for those who received the largest co-payment relief and lived in metropolitan regions, whereas the reduction in specialist attendances was concentrated among lower income Indigenous patients.Affirmative action can reduce inequalities in Indigenous use of primary healthcare, albeit careful design is required to ensure that benefits are equitable and do not lead to substitution away from valuable, or necessary, care.

Medication-related problems identified by community pharmacists: a descriptive case study of two Australian populations

“…Further work is required to explore contributing factors to adherence issues in this population, however, these may include previously identified challenges such as misconceptions regarding medications and lack of culturally appropriate information sources [ 20 ]. Barriers to accessing care have been acknowledged by policymakers, with system level strategies implemented to improve access to medicines and healthcare for Indigenous Australians [ 40 ]. Conversely, adherence issues with psychotropic medications is well documented in people living with SPMI, with many factors, including the adverse effects of psychotropic medications such as those reported as MRPs in this current study, contributing to poor adherence [ 41 ].…”

Medicare and Priority Populations: Structural and Place‐based Considerations for Aboriginal and Torres Strait Islander Peoples and LGBTIQ+ Australians

“…Previous research has shown that the 2010 reforms increased use of primary care services and prescription medicines among Indigenous peoples (Trivedi and Kelaher 2020; Saxby et al 2023) and that hospitalisations associated with chronic conditions declined in areas with higher uptake of the reform (Trivedi et al 2017). While this reform has clearly reduce inequalities in primary healthcare, empirical research also suggests that they have had little to zero impact on access to specialist services (Saxby et al 2023). Further research on this is required to understand whether this is driven by reduced need for specialist care or reinforced substitution away from specialist care.…”

“…Despite innovative, responsive and culturally driven models of care, chronic conditions are a leading contributor to premature mortality among Indigenous peoples (Australian Indigenous HealthInfoNet, 2022; Brown 2012). Moreover, Indigenous peoples continue to experience barriers to engaging with mainstream healthcare, including a lack of culturally appropriate care, experiencing discrimination within the healthcare setting and scarce supply of specialist care (Marrone 2007; Hollinsworth 2010; Saxby et al 2023).…”