Overall, estimated expenditure on health services provided to Aboriginal and Torres Strait Islander peoples during 2001-02 was $3,901 per head. This was 18% higher (ratio 1.18:1) than the estimated expenditure on services delivered to non-Indigenous Australians. The ratio of per capita expenditure on Indigenous Australians to non-Indigenous Australians varies considerably by type of service. Aboriginal and Torres Strait Islander peoples were more intensive users of community health centres (where the per capita expenditure rate ratio was 6.5, public health (2.9) and admitted and non-admitted patient services within the public hospital system (1.6 and 1.9 respectively) compared with medical services (0.4) and pharmaceuticals (0.3).
Access to services is affected by a number of factors including the proximity of the service, availability of transport, affordability, availability of culturally appropriate services and the involvement of Indigenous people in the delivery of health services. Approximately one in five Indigenous people living in remote areas have difficulty understanding and/or being understood by service providers and around one-half do not have a working telephone in the home.
Indigenous participation in the delivery of services is considered an important issue in improving access to services. In 2001, Indigenous people were under-represented in selected health-related occupations, comprising around 1% of Australians employed in this area. Aboriginal and Torres Strait Islander people were somewhat better represented in welfare and community-related occupations, accounting for 2.6% of all people employed in this sector. Indigenous students remained under-represented among those completing graduate courses in health (1.0%) in 2003. However, higher proportions of Indigenous people were commencing health and welfare-related courses in 2003 (1.7% and 2.3% respectively).
Despite likely under-counting of Aboriginal and Torres Strait Islander people in hospital records, in 2003-04, Indigenous males and females were about twice as likely to be hospitalised as other males and females, with the greatest differences in rates being in the age groups 35-44 years, 45-54 years and 55-64 years. Once in hospital, however, Indigenous patients were less likely to undergo a procedure than other patients.
For all age groups, hospitalisation rates for Indigenous Australians were higher than for other Australians. While hospitalisation rates for Indigenous Australians are several times those for other Australians, most of the difference is due to high rates of care involving dialysis and hospitalisations for other potentially preventable chronic conditions. Indigenous males and females were hospitalised for care involving dialysis at nine and 17 times the rate of other Australian males and females, and for potentially preventable chronic conditions they were hospitalised at seven times the rate of other Australians.
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