Department of Health, Manunda Place, 38 Cavenagh Street, Darwin, NT 0811, Australia; and Menzies School of Health Research, NT, Australia.
Menzies School of Health Research, NT, Australia.
Aust Health Rev. 2022 Jun;46(3):302-308. doi: 10.1071/AH21276.
Objective To analyse Medicare expenditure by State/Territory, remoteness, and Indigenous demography to assess funding equality in meeting the health needs of remote Indigenous populations in the Northern Territory. Methods Analytic descriptions of Medicare online reports on services and benefits by key demographic variables linked with Australian Bureau of Statistics data on remoteness and Indigenous population proportion. The Northern Territory Indigenous and non-Indigenous populations were compared with the Australian average between the 2010/2011 and 2019/2020 fiscal years in terms of standardised rates of Medicare services and benefits. These were further analysed using ordinary least squares, simultaneous equations and multilevel models. Results In per capita terms, the Northern Territory receives around 30% less Medicare funds than the national average, even when additional Commonwealth funding for Aboriginal medical services is included. This funding shortfall amounts to approximately AU$80 million annually across both the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme. The multilevel models indicate that providing healthcare for an Aboriginal and Torres Strait Islander person in a remote area involves a Medicare shortfall of AU$531-AU$1041 less Medicare Benefits Schedule benefits per annum compared with a non-Indigenous person in an urban area. Indigenous population proportion, together with remoteness, explained 51% of the funding variation. An age-sex based capitation funding model would correct about 87% of the Northern Territory primary care funding inequality. Conclusions The current Medicare funding scheme systematically disadvantages the Northern Territory. A needs-based funding model is required that does not penalise the Northern Territory population based on the remote primary health care service model.
目的 通过分析各州/领地、偏远地区和原住民人口统计数据的医疗保险支出,评估北领地为满足偏远地区原住民健康需求而提供资金的公平性。
方法 对医疗保险在线报告中的服务和福利数据进行分析,根据关键人口统计学变量进行分类,并与澳大利亚统计局关于偏远地区和原住民人口比例的数据进行关联。将 2010/2011 财年至 2019/2020 财年期间北领地的原住民和非原住民人口与澳大利亚的平均水平进行比较,比较内容包括标准化的医疗保险服务和福利比率。然后,使用普通最小二乘法、联立方程和多层模型对这些数据进行进一步分析。
结果 按人均计算,即使包括对原住民医疗服务的联邦额外拨款,北领地获得的医疗保险资金也比全国平均水平少约 30%。医疗保险福利计划和药品福利计划每年的资金短缺总额约为 8000 万澳元。多层模型表明,与城市地区的非原住民相比,在偏远地区为原住民和托雷斯海峡岛民提供医疗保健服务,医疗保险福利计划的福利每年会减少 531 澳元至 1041 澳元。原住民人口比例以及偏远程度共同解释了 51%的资金差异。按年龄和性别计算的人头拨款模式将纠正北领地初级保健资金不平等的约 87%。
结论 目前的医疗保险资金分配方案对北领地存在系统的不利影响。需要建立一种基于需求的资金分配模式,而不是基于偏远地区初级卫生保健服务模式来惩罚北领地的人口。