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Self-reported information on the use of health services is available from the 2001 NHS, including information for Indigenous people from the NHS Indigenous component (NHS(I)) (ABS 2002b, 2002c). After adjusting for age differences, in 2001 Indigenous people were more likely to have taken at least one health-related action (53%) than non-Indigenous people (47%). For both Indigenous and non-Indigenous Australians, the most commonly reported recent health action was a consultation with a doctor. Indigenous people were more likely than non-Indigenous people to consult with a health professional other than a doctor or dentist, to attend hospital (either as admitted patients or outpatients), or to seek emergency or day clinic services.

Indigenous people in remote areas were more likely to have been admitted to hospital (21%) or to have visited an emergency or outpatients department (9%) than Indigenous people in non-remote areas (19% and 5% respectively).

The Western Australian Aboriginal Child Health Survey (WAACHS), a large-scale survey of the health of 5,289 Western Australian Aboriginal children aged 0-17 years in 2001 and 2002, collected information on the use of health services. About 49% of Aboriginal children had visited a doctor in the six months prior to the survey, 25% had visited a nurse and 21% had visited a dentist. Indigenous children with a non-Indigenous primary carer were more likely to have visited a doctor, dentist, specialist and hospital emergency than were children with an Indigenous primary carer. On the other hand, a higher proportion of children with an Indigenous carer had seen an Aboriginal Health Worker and visited an Aboriginal Medical Service than children with a non-Indigenous carer.

Community controlled primary health services

Health services that are initiated, controlled and operated by the Indigenous community have the potential to increase the level of access to health services for Aboriginal and Torres Strait Islander peoples by providing holistic and culturally appropriate care. A review of the Australian Government’s Aboriginal and Torres Strait Islander Primary Health Care Program (Primary Health Care Review, undertaken through an inter-departmental committee) was completed in 2003-04. The Review found that access to comprehensive primary health care is an essential component of action to improve health status and that the Australian Government had made significant progress in increasing the provision of such services. It found that in areas where these services were adequately developed, more Aboriginal and Torres Strait Islander people were having disease detected and treated as well as taking part in programs to improve health. In these areas, reductions in communicable disease such as pneumococcal disease, improved detection and management of chronic disease such as diabetes, and better child and maternal health outcomes including reductions in preterm births and increases in birthweight were evident (Dwyer et al. 2004).

In 2003-04, the Office for Aboriginal and Torres Strait Islander Health (OATSIH) in the Australian Government Department of Health and Ageing funded 140 services to provide or facilitate access to primary health care for Aboriginal and Torres Strait Islander people. Two-thirds of these services (92) were in outer regional, remote or very remote locations (graph 10.10).

6.10 Australian government-funded Aboriginal and Torres Strait Islander primary health care services - 2003-04

6.11 Australian Government funded Aboriginal and Torres Strait Islander primary health care services, Selected health-related activities undertaken/facilitated - 2003-04

General practice

In addition to access to community controlled health services, Indigenous Australians also consult with private GPs. Information about the extent to which GPs are used by both Indigenous and other Australians is available from the survey of general practice activity in Australia known as the Bettering the Evaluation And Care of Health (BEACH) survey. The results of the consultations between Indigenous people and GPs for the period 1998-99 to 2002-03 are presented in Chapter 7 (table 7.8). The most commonly managed problems at GP consultations with Indigenous patients were respiratory conditions, skin problems, musculoskeletal problems, psychological problems, circulatory problems and endocrine, metabolic and nutritional diseases (including diabetes).

Over the five-year period 1998-99 to 2002-03, there were 5,476 GP consultations with Aboriginal and Torres Strait Islander patients, representing 1.1% of total GP consultations. This rate of consultation is low, relative to the proportion of Indigenous peoples in the total population (2.4% at 30 June 2001). These lower figures may be the result of: the geographic distribution of GPs not reflecting that of the Indigenous population; lower use of private GP services by Indigenous peoples where other services such as Aboriginal primary health care services exist; Indigenous peoples' lower use of hospital emergency departments or pharmacists, especially in remote areas; failure by GPs to record the Indigenous status of patients; or reluctance of patients to identify as Indigenous. Supplementary surveys in recent years, together with investigations of the means for better ascertaining the Indigenous status of patients in the BEACH survey, have suggested ways for improving such data in the future.

Other reasons for the relatively low proportion of total consultations with Aboriginal Torres Strait Islander patients may also include or Indigenous peoples using other services such as hospital emergency departments or pharmacists, especially in remote areas.

Alcohol and other drug treatment services

Information on the use of alcohol and other drug treatment services by Aboriginal and Torres Strait Islander people is available from the Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS-NMDS). The information collected by the AODTS-NMDS is a nationally agreed set of common data items collected by government-funded services for alcohol and other drug treatments (AIHW 2005a). Data for 2003-04, the fourth year of collection, are presented here.

There were 13,238 (10%) closed treatment episodes involving clients who identified themselves as being of Aboriginal and/or Torres Strait Islander origin in the 2003-04 collection (table 10.12). This is higher than the overall proportion of Indigenous people in the total Australian population. For a number of reasons the data on Aboriginal and Torres Strait Islander clients in the AODTS treatment population should be interpreted with caution. The identification of Indigenous users of these services may not be complete. Further, the majority of dedicated substance use services for Aboriginal and Torres Strait Islander people are not included in the AODTS-NMDS collection.

6.12 Closed treatment episodes, by Indigenous status - 2003-04
	Indigenous		Other(a)		Total
Age (years)	no.	%	no.	%	no.	%
10-19	2 625	1.9	14 434	10.5	17 059	12.5
20-29	4 124	3.0	40 560	29.6	44 684	32.6
30-39	3 963	2.9	34 203	25.0	38 166	27.9
40-49	1 859	1.4	21 705	15.9	23 564	17.2
50-59	445	0.3	8 662	6.3	9 107	6.7
60 or over	89	0.1	3 051	2.2	3 140	2.3
Not stated	133	0.1	1 016	0.7	1 149	0.8
Total episodes	13 238	9.7	123 631	90.3	136 869	100.0
(a) Includes closed treatment episodes for clients for whom Indigenous status was not stated.
AIHW 2005a

Overall, closed treatment episodes involving Aboriginal and Torres Strait Islander clients were most likely to involve alcohol (46%), cannabis (22%), heroin (11%) and amphetamines (9%) - that is, the same four principal drugs of concern as for other Australians - but with alcohol much more likely to be nominated (46%, compared with 37%) and heroin less so (11%, compared with 19% (graph 10.13).

6.13 Closed treatment episodes, by selected principal drug of concern - 2003-04

The Drug and Alcohol Service Report (DASR) is coordinated by OATSIH. The DASR collects information from all Australian Government-funded Aboriginal and Torres Strait Islander substance use specific services. In 2003-04, 41 services (98% of funded services) provided DASR data. Of these, 29 were classified as residential substance use services and 12 were classified as non-residential.

Some data from this collection are presented below to provide a broader picture of the types of treatments being accessed by the Indigenous population for drug and alcohol problems. It should be noted that the DASR and AODTS-NMDS have different collection purposes, scope and counting rules. For example, the DASR collect service-level estimates for client numbers and episodes of care while the AODTS-NMDS collects unit records for closed treatment episodes (and some data on client registrations).

In 2003-04, an estimated 24,864 clients were seen by Australian Government funded Aboriginal and Torres Strait Islander substance use-specific services, some 21,242 or 85% of whom were Indigenous clients. Residential treatment/rehabilitation was the most common treatment type for both Indigenous males and females (table 10.14). Approximately 84% of clients receiving residential treatment or rehabilitation were Indigenous and 95% of clients receiving sobering-up or residential respite care were Indigenous. A greater number of males were seen by Australian Government funded Aboriginal and Torres Strait Islander substance use specific services than females across all treatment types.

For the same period, Australian Government funded Indigenous substance use-specific services provided 4,013 episodes of care for residential treatment/rehabilitation and 6,554 episodes of care for sobering up/residential respite care, of which 83% and 98% were for Indigenous clients. Around two-thirds (65%) of all episodes of care involving Indigenous clients for these two treatment types were for Indigenous males.

In addition, there were 34,986 episodes of care for counselling and therapy, after-care follow-up and preventative care, all of which are not residential based. Of these, 83% were episodes of care for Indigenous clients.

6.14 Use of Government-funded Aboriginal and Torres Strait Islander substance-use services, by Indigenous status - 2003-04
	Number of clients			Proportion of clients within each treatment type
	Male	Female	Persons	Male	Female	Persons
Treatment type	no.	no.	no.	%	%	%
Residential treatment/rehabilitation (n=29)(a)
Indigenous	1 947	919	2 866	81.0	89.3	83.5
Non-Indigenous	456	110	566	19.0	10.7	16.5
Total	2 403	1 029	3 432	100.0	100.0	100.0
Sobering-up/residential respite (n=10)(b)
Indigenous	1 931	782	2 713	94.6	97.1	95.3
Non-Indigenous	110	23	133	5.4	2.9	4.7
Total	2 041	805	2 846	100.0	100.0	100.0
Other care (n=38)(c)
Indigenous	7 279	1 993	9 272	61.5	66.9	62.6
Non-Indigenous	4 550	985	5 535	38.5	33.1	37.4
Total	11 829	2 978	14 807	100.0	100.0	100.0
Total (n=40)(d)
Indigenous	13 429	7 813	21 242	84.2	87.6	85.4
Non-Indigenous	2 519	1 103	3 622	15.8	12.4	14.6
Total	15 948	8 916	24 864	100.0	100.0	100.0
(a) Includes people who were officially clients of the service, that is, people who received treatment/rehabilitation in a residential setting and had their own file/record.
(b) Sobering-up clients are in residential care overnight to sober-up and do not receive formal rehabilitation. Respite clients spend one to seven days in residential care for the purpose of respite and do not receive formal rehabilitation.
(c) Clients receiving ‘other care’ received non-residential care (e.g. counselling, assessment, treatment, education, support, home visits, and/or Mobile Assistance Patrol/Night Patrol) or follow-up from residential services after discharge.
(d) 'Total’ refers to the number of clients of a Service. It does not always equate to total number of clients in all programs as some clients may be in multiple programs. The total number of services reported (40) does not include one service which closed during the 2003-2004 financial year.
DASR, Department of Health and Ageing, unpublished data
1. In 2003-04, a small number of agencies in in the DASR and SAR data collections (three DASR, six SAR) were also included in the AODTS-NMDS. 2. N = number of services.

In 2003-04, all Australian Government-funded Aboriginal and Torres Strait Islander substance use specific services provided treatment or assistance for alcohol use and 88% of services indicated that alcohol was the one substance/drug that affected the largest number of their clients. In the same period, 93% of services provided assistance or treatment for cannabis use, 78% for multiple drug use, 66% for amphetamine use, 56% for tobacco use and 54% for heroin use. Less than half of all services provided treatment or assistance for the use of other drugs such as benzodiazepines, inhalants, petrol and barbiturates.

Aboriginal and Torres Strait Islander primary health care services also provide support in relation to substance use issues. In 2003-04, 98% of Australian Government funded Aboriginal and Torres Strait Islander primary health care services (SAR) provided one or more substance use services. It is not possible to estimate the number of clients that attended Aboriginal and Torres Strait Islander primary health care services and received alcohol or other drug treatment. Similarly, it is not possible to estimate the number of reported episodes of care that related solely or partially to alcohol or other drug treatment.

Community mental health services

Information on the use of community mental health services by Aboriginal and Torres Strait Islander people is available from the AIHW National Community Mental Health Care Database (NCMHCD). The information collected in the database is a nationally agreed set of common data elements. Data for 2002-03 are presented here.

Community mental health care is defined as care which is provided by specialised public mental health services dedicated to the assessment, treatment, rehabilitation and care of non-admitted clients. This excludes specialised mental health care for admitted patients, support that is not provided by specialised mental health care services, care provided by non-government organisations, and residential care.

In 2002-03, there were 147,531 service contacts (3%) for clients who identified themselves as being of Aboriginal and/or Torres Strait Islander origin (table 10.15). After adjusting for age, the rate at which community mental health services were accessed by Aboriginal and Torres Strait Islander peoples was 1.4 times that of other Australians (342 and 236 service contacts per 1,000 population respectively).

These rates should be interpreted with caution, however, as there is likely to be an under-estimate of the actual number of service contacts for Indigenous clients. Indigenous clients may have been reported as non-Indigenous or they may have been represented within the service contacts with a ‘not stated’ Indigenous status (8%). In addition, some of the data reported for the ‘Both Aboriginal and Torres Strait Islander’ category are suspected to be affected by misinterpretation of this category to include non-Aboriginal and Torres Strait Islander peoples (e.g. Maoris and South Sea Islanders). All state and territory health authorities, excluding Tasmania, provided information on the quality of 2002-03 NCMHCD data. With the exception of the Northern Territory, the quality of Indigenous status data was considered to be in need of improvement in all states and territories (AIHW 2004e).

Aboriginal and Torres Strait Islander peoples had higher proportions of service contacts for the younger age groups than did other Australians, and lower proportions in the older age groups, reflecting differences in the age structure of these populations. For example, 24% of service contacts for Indigenous Australian males were for clients aged 15-24 years compared with 16% of service contacts for other Australian males (table 10.15). Proportions of service contacts for females showed a similar pattern (21% and 16% respectively).

6.15 Community mental health service contacts(a) - 2002-03
		Indigenous		Other(b)		Total
		no.	%	no.	%	no.	%
Males
	Less than 15 years	10 647	13.8	256 792	11.1	267 439	11.2
	15-24 years	18 539	24.1	373 800	16.2	392 339	16.5
	25-34 years	26 396	34.3	551 115	23.9	577 511	24.2
	35-44 years	12 380	16.1	482 709	20.9	495 089	20.8
	45-54 years	5 609	7.3	312 105	13.5	317 714	13.3
	55-64 years	1 849	2.4	148 984	6.5	150 833	6.3
	65 years or over	1 315	1.7	179 279	7.8	180 594	7.6
	Total(c)	76 951	100.0	2 306 864	100.0	2 383 815	100.0
Females
	Less than 15 years	5 184	7.4	150 183	6.9	155 367	6.9
	15-24 years	15 098	21.4	356 391	16.3	371 489	16.5
	25-34 years	20 534	29.1	401 079	18.4	421 613	18.7
	35-44 years	17 038	24.2	417 366	19.1	434	404.0
	45-54 years	7 246	10.3	334 253	15.3	341 499	15.2
	55-64 years	3 432	4.9	197 948	9.1	201 380	8.9
	65 years or over	1 889	2.7	321 973	14.8	323 862	14.4
	Total(c)	70 453	100.0	2 181 529	100.0	2 251 982	100.0
All contacts(c)		147 531	. .	4 524 892	. .	4 672 423	. .
. . not applicable
(a) These data should be interpreted with caution due to likely under-identification of Indigenous Australians.
(b) Includes service contacts for clients for whom Indigenous status was not stated.
(c) Includes service contacts for clients for whom age or sex was not stated.
AIHW 2004e

There were differences in the principal diagnoses most commonly reported for Aboriginal and Torres Strait Islander people and those for other Australians. A smaller proportion of Indigenous people had principal diagnoses of 'schizophrenia, schizotypal and delusional disorders' (45%) and 'mood (affective) disorders' (21%), than did other Australians (47% and 24% respectively) (graph 10.16). However, Indigenous people were more likely to have a principal diagnosis of disorders due to psychoactive substance use (8%) than other Australians (3%).

6.16 Service contacts for which a specific principal diagnosis was reported, by selected principal diagnosis - 2002-03

While information on hospitalisation can provide insights into the health of the population they represent, the reasons for which people are hospitalised and the procedures they may undergo in hospital are not necessarily indicative of the health of the total population. Hospitalisation statistics are limited to information about the conditions for which people are admitted to hospital, thereby excluding information regarding those who have made use of other health services, such as GPs and community health clinics, and those who have not accessed health care at all. The number and pattern of hospital admissions can also be affected by the variation between hospitals in decisions about whether to admit patients or to treat them as non-admitted patients; information concerning non-admitted patients is not routinely reported. Other factors, such as the availability of, and access to, other medical services, may influence hospital utilisation. A rising rate of hospitalisation, for example, could mean that health status has deteriorated, or that access to hospitals has improved, or both.

HOSPITALISATIONS

Measures of hospitalisation among the Indigenous population are influenced by the quality of the data on Indigenous status, which is likely to vary between the states and territories (see Chapter 7, box 7.9 for more detail). They are also influenced by variation among the jurisdictions in the health status of Indigenous people and in their access to hospital services (AIHW 2005b). The identification of Aboriginal and Torres Strait Islander patients in hospital records is considered to be in need of improvement in New South Wales, Victoria, Queensland, Tasmania and the Australian Capital Territory (AIHW 2005b) and thus true hospitalisation rates for Aboriginal and Torres Strait Islander people are likely to be higher than those reported in this chapter.

In Australia during 2003-04, there were 6.8 million hospitalisations recorded. Of these, 216,142 or 3% were recorded as Indigenous. The same patient may have been hospitalised more than once during this period. After adjusting for age, Indigenous males and females were about twice as likely to be hospitalised as other males and females.

In 2003-04, about 94% of hospitalisations involving Indigenous patients were recorded in public hospitals, compared with 60% for other Australians. While Indigenous patients are probably not usually identified well in private hospitals compared to public hospitals, the much lower proportion of hospitalisations of Indigenous patients in private hospitals probably largely reflects lower attendance at private hospitals by Indigenous patients.

In 2003-04 and for many diagnoses, the hospitalisation rates for Indigenous patients were higher than for other patients (table 10.17). Hospitalisation rates for a diagnosis of care involving dialysis were around nine times as high for Indigenous males and 17 times as high for Indigenous females. Similarly, Indigenous males and females were around three times as likely as other males and females to be hospitalised for endocrine, nutritional and metabolic diseases, which includes diabetes.

Hospitalisation rates for some diagnoses such as diseases of the digestive system were lower among Indigenous Australians than other Australians. At present it is not possible to ascertain the extent to which this is due to under-identification of Indigenous patients or to genuinely lower rates of hospital use for these conditions.

6.17 Hospitalisations of Indigenous persons, by principal diagnosis - 2003-04
	Hospitalisations of Indigenous persons		Proportion of hospitalisations involving Indigenous persons		Ratio(a)
	Males	Females	Males	Females	Males	Females
	no.	no.	%	%
Injury poisoning and certain other consequences of external causes (S00-T98)	9 633	7 685	10.3	6.2	1.7	2.3
Pregnancy, childbirth and the puerperium (O00-O99)	. .	16 783	. .	13.6	. .	1.4
Diseases of the respiratory system (J00-J99)	8 005	8 035	8.6	6.5	2.0	2.4
Diseases of the digestive system (K00-K93)	5 775	5 829	6.2	4.7	0.9	0.8
Mental and behavioural disorders (F00-F99)	4 954	4 604	5.3	3.7	2.1	1.5
Symptoms, signs and abnormal clinical and laboratory findings, n.e.c. (R00-R99)	4 199	5 118	4.5	4.2	1.5	1.4
Factors influencing health status and contact with health services (Z00-Z99)	3 302	4 425	3.5	3.6	0.7	0.7
Diseases of the circulatory system (I00-I99)	3 845	3 415	4.1	2.8	1.8	2.1
Diseases of the genitourinary system (N00-N99)	1 475	4 474	1.6	3.6	0.9	1.1
Diseases of the skin and subcutaneous tissue (L00-L99)	2 731	2 499	2.9	2.0	2.4	2.7
Certain infectious and parasitic diseases (A00-B99)	2 581	2 488	2.8	2.0	1.9	2.0
Endocrine, nutritional and metabolic diseases (E00-E90)	2 003	2 288	2.2	1.9	3.1	2.8
Other	8 949	8 863	9.6	7.2	1.0	0.8
Total excluding care involving dialysis	57 562	76 596	61.8	62.3	1.3	1.3
Care involving dialysis (Z49)	35 560	46 423	38.2	37.7	8.9	17.0
Total(b)	93 122	123 019	100.0	100.0	1.9	2.0
. . not applicable
(a) Ratio is observed hospitalisations divided by expected hospitalisations. Expected hospitalisations are calculated based on the age, sex and cause-specific rates of other Australians.
(b) Includes hospitalisations for which no principal diagnosis was recorded.
AIHW, National Hospital Morbidity Database

Age-specific hospitalisation rates are shown in graph 10.18. Overall, higher hospitalisation rates were recorded for Indigenous patients than for other patients in all age groups. The highest difference in rates occurred in the age groups between 25 and 64 years.

6.18 Age-specific hospitalisation rates, by Indigenous status - 2003-04

Overall, Indigenous Australians were seven times as likely as other Australians to be hospitalised for potentially preventable chronic conditions. Of these chronic conditions, diabetes complications had the highest hospitalisation rate, with Indigenous Australians almost fourteen times as likely as other Australians to be hospitalised as a result of this condition. Indigenous Australians were hospitalised for chronic obstructive pulmonary diseases at six times the rate, and for hypertension, at five times the rate, of other Australians.

6.19 Hospitalisations for potentially preventable chronic diseases - 2003-04
	Indigenous		Other(a)
	Observed	Expected	Observed	Ratio(b)
	no.	no.	no.	%
Diabetes complications	20 547	1 494	173 589	13.8
Chronic obstructive pulmonary diseases	2 260	353	55 655	6.4
Asthma	2 032	1 241	35 957	1.6
Angina	1 300	330	44 334	3.9
Congestive cardiac failure	997	211	41 895	4.7
Iron deficiency anaemia	334	192	18 990	1.7
Hypertension	285	58	6 348	4.9
Nutritional deficiencies(c)	24	3	119	8.3
Total chronic diseases(d)	26 971	3 802	364 190	7.1
(a) Includes hospitalisations of non-Indigenous people and hospitalisations of people for whom Indigenous status was not stated.
(b) Ratio is observed hospitalisations divided by expected hospitalisations. Expected hospitalisations are calculated based on the age, and cause-specific rates of other Australians.
(c) The Indigenous nutritional deficiencies standardised rate is based on only 20 separations and should be used with caution.
(d) The total is not the sum of the individual conditions because diabetes complications may be treated in conjunction with other conditions based on the principal diagnosis.
AIHW, National Hospital Morbidity Database

Indigenous Australians were more likely to be hospitalised for potentially preventable chronic diseases than other Australians. In the age group where chronic conditions are usually most prevalent (45-64 years), the hospitalisation rate for Indigenous Australians for potentially preventable chronic conditions was 16 times that for other Australians. Much of the difference in hospitalisation rates between Indigenous and other Australians is due to hospitalisations from dialysis and other potentially preventable chronic diseases (graph 10.20). Dialysis and other potentially preventable conditions represented approximately 72% of all hospitalisations of Indigenous people aged 45 years or over compared with 21% of hospitalisations for other Australians of the same age.

6.20 Hospitalisation rates for all conditions excluding dialysis and other potentially preventable chronic diseases, by Indigenous status - 2003-04

While Indigenous Australians were more likely to be hospitalised than other Australians, they were less likely to undergo a procedure while in hospital. In 2003-04, 72% of hospitalisation episodes involving Indigenous patients included the performance of a procedure, compared with 81% of other hospitalisation episodes. When care involving dialysis was excluded, 54% of Indigenous hospitalisation episodes included a procedure being performed compared with 79% of other hospitalisation episodes.

In 2003-04, the proportion of hospitalisations with a procedure recorded, excluding care involving dialysis, was highest for Indigenous patients aged 55-64 years (table 10.21). Patients who lived in remote areas were less likely to undergo a procedure (43% of Indigenous and 55% of other patients) than those living in major cities (68% and 72% for Indigenous and other patients respectively).

6.21 Hospitalisations with a procedure recorded(a), Australian public hospitals - 2003-04
		Indigenous(b)	Other(b)
		%	%
Overall		54.1	69.7
Sex
	Males	53.5	69.5
	Females	54.6	69.9
Age (years)
	Less than 1	40.1	45.7
	1-14	47.2	56.7
	15-34	49.3	64.0
	35-54	50.6	72.1
	55-64	56.7	76.6
	65 or over	55.0	75.2
Place of residence(c)
	Major cities	69.9	72.2
	Regional	53.4	66.5
	Remote	43.9	55.3
	Unknown	56.1	56.6
Same-day admission
	Yes	58.0	73.6
	No	53.0	67.0
Patient accommodation
	Private	64.9	74.8
	Public	54.3	68.9
(a) Hospitalisations with a principal diagnosis of care involving dialysis (Z49) have been excluded.
(b) All proportions have been indirectly age-standardised using the age-specific rates for other Australians.
(c) Differences in Indigenous identification by place of residence will affect the estimated rates.
AIHW, National Hospital Morbidity Database

Some of the differences in the overall procedure rate could be due to different diagnosis patterns between the two population groups. Nevertheless, for almost all principal diagnoses, Indigenous patients were less likely than other patients to have one or more procedure recorded (table 10.22). Principal diagnoses of certain infectious and parasitic diseases, certain conditions originating in the perinatal period and factors influencing health status and contact with health services were the only exceptions to this.

6.22 Hospitalisations with a procedure recorded, by principal diagnosis - 2003-04
	Proportion with a procedure(a)
	Indigenous	Other
	%	%
Factors influencing health status and contact with health services (Z00-Z99)	96.1	95.0
Congenital malformations deformations and chromosomal abnormalities (Q00-Q99)	89.0	91.7
Neoplasms (C00-D48)	86.8	95.5
Diseases of the eye and adnexa (H00-H59)	85.3	98.2
Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89)	84.1	93.2
Diseases of the ear and mastoid process (H60-H95)	73.2	86.0
Certain conditions originating in the perinatal period (P00-P96)	71.0	67.0
Diseases of the musculoskeletal system and connective tissue (M00-M99)	66.5	91.2
Diseases of the digestive system (K00-K93)	61.5	88.6
Pregnancy childbirth and the puerperium (O00-O99)	60.7	74.9
Endocrine, nutritional and metabolic diseases (E00-E90)	60.4	78.3
Diseases of the genitourinary system (N00-N99)	60.2	85.4
Injury poisoning and certain other consequences of external causes (S00-T98)	57.0	70.1
Diseases of the skin and subcutaneous tissue (L00-L99)	55.8	73.7
Diseases of the circulatory system (I00-I99)	48.0	72.0
Diseases of the nervous system (G00-G99)	41.7	78.5
Certain infectious and parasitic diseases (A00-B99)	37.6	37.7
Diseases of the respiratory system (J00-J99)	33.2	58.2
Mental and behavioural disorders (F00-F99)	33.1	47.2
Symptoms signs and abnormal clinical and laboratory findings n.e.c. (R00-R99)	30.3	55.9
Total	71.5	80.9
(a) Proportions are indirectly age-standardised using the age and cause-specific rates for other Australians.
AIHW, National Hospital Morbidity Database

Aboriginal and Torres Strait Islander people who are admitted to hospital are less likely to have a procedure recorded for a number of possible reasons. These include communication difficulties due to language, institutional factors such as under-servicing in remote areas which disproportionately affects Indigenous people as they are more likely to live in remote areas, and systematic/discriminatory differences in the treatment of patients identified as Indigenous in terms of access to services, diagnosis, referral and treatment (Cunningham 2002).

A recent study by Coory and Walsh (2005), which followed patients admitted to Queensland hospitals for acute myocardial infarction (AMI) between 1998 and 2002, found that rates of coronary procedures among Indigenous patients were significantly lower (by 22%) than among other patients with AMI.

PROCEDURES

In 2003-04, approximately 2% of all procedures were performed on Indigenous patients (264,169). The most common types of procedures recorded for Indigenous people in 2003-04 were procedures on the urinary system, the majority of which were for haemodialysis (table 10.23). Some 32% of procedures for Indigenous males and females were for haemodialysis, a procedure which artificially performs the work of the kidneys in patients with end-stage renal disease. For more detail on dialysis and end-stage renal disease, see the section in Chapter 7 on chronic kidney disease. Non-invasive, cognitive and other interventions, not elsewhere classified, were the second most common type of procedure for both males and females. A large proportion of procedures in this group were for allied health interventions such as physiotherapy and social work and for general anaesthesia and sedation.

For Indigenous males, hospital procedure rates for the urinary system and the respiratory system were higher than for other Australian males (approximately seven and two times as high respectively). For Indigenous females, hospital procedure rates on the respiratory system, cardiovascular system and urinary system were higher than for other females (two, two and 12 times as high respectively).

6.23 Hospital procedures, Indigenous persons - 2003-04
	Hospital procedures performed on Indigenous persons		Proportion of procedures performed on Indigenous persons		Ratio(a)
	Males	Females	Males	Females	Males	Females
ICD-10-AM procedure chapter	no.	no.	%	%	%	%
Non-invasive cognitive and other interventions n.e.c. (1820-1916)	37 471	47 142	32.8	31.5	1.0	1.0
Obstetric procedures (1330-1347)	. .	12 141	. .	8.1	. .	1.0
Imaging services (1940-2016)	5 462	5 036	4.8	3.4	1.3	1.4
Procedures on digestive system (850-1011)	4 208	5 733	3.7	3.8	0.6	0.6
Dermatological and plastic procedures (1600-1718)	5 393	4 235	4.7	2.8	1.1	1.0
Dental services (450-490)	4 777	4 811	4.2	3.2	0.7	0.6
Procedures on musculoskeletal system (1360-1579)	6 020	3 520	5.3	2.3	0.9	0.9
Procedures on cardiovascular cystem (600-767)	4 347	3 759	3.8	2.5	1.4	1.8
Gynaecological procedures (1240-1299)	. .	6 659	. .	4.4	. .	0.6
Procedures on respiratory system (520-569)	3 014	2 342	2.6	1.6	1.7	2.0
Procedures on urinary system (1040-1129)(b)	1 420	1 506	1.2	1.0	0.9	1.1
Other procedures	6 072	5 621	5.3	3.8	0.6	0.6
Total excluding haemodialysis	78 184	102 505	68.4	68.4	0.9	0.9
Haemodialysis (1060)	36 171	47 309	31.6	31.6	8.9	17.1
Total(c)	114 355	149 814	100.0	100.0	1.3	1.3
. . not applicable
(a) Ratio is observed procedures divided by expected procedures. Expected procedures are based on the age, sex and cause-specific rates for other Australians.
(b) Excludes haemodialysis.
(c) Includes procedures for which no procedure code was recorded. Excludes procedures performed on persons for whom Indigenous status was not stated.
AIHW, National Hospital Morbidity Database