New research shows complexity of Indigenous health funding an
impediment to success
August 17 2009
The use of overly complex and fragmented funding methods is undermining
the efforts of the Aboriginal health sector to close the health inequity gap
according to a new Cooperative Research Centre for Aboriginal Health report
to be launched in Canberra today by Social Justice Commissioner, Tom
Calma.
The Overburden Report: Contracting for Indigenous Health Services
investigated the way Governments fund Aboriginal Community Controlled
Health Services which are effective providers of comprehensive primary
health care to Indigenous people across the country.
Project leader and Flinders University Professor Judith Dwyer said the
research had demonstrated that these funding arrangements are inefficient,
and could actually compromise a central policy plank of government efforts to
close the health inequity gap.
“Government policies are designed to promote an effective community-
controlled health sector delivering comprehensive primary health care (PHC)
for Aboriginal and Torres Strait Islander people but then the funding
arrangements developed by those same governments too often undermine
this objective,” said Professor Dwyer.
Professor Dwyer said that ACCHSs are funded in more complex ways, and
from more sources, than equivalent mainstream health care organisations,
and this is a barrier to providing responsive care, and brings heavy overhead
costs.
“In one case an Aboriginal health service operating in a remote area was
funded from 42 different buckets of money and all of these required separate
applications and had separate reporting requirements. Some of these funding
grants were as low as one thousand dollars,” said Professor Dwyer. “It’s not
hard to imagine how accounting and reporting on this multitude of grants is a
waste of precious health resources.
“It’s difficult to pull together effective comprehensive primary health care from
a series of specific purpose grants all with separate reporting requirements,”
she said. “Primary health care needs to be responsive to the whole person or
family, regardless of the different kinds of health needs they have. No other
primary health providers are expected to cobble together a responsive whole
service on the basis of tightly targeted funding for specific health problems.
Targeted funding can only work when there is adequate core funding of PHC
services to support it.
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“Properly supporting the ongoing successes of the ACCHS will require a
different way of thinking about the relationship between government and the
sector. The funding and reporting need to be simplified, and there needs to be
more focus on the long-term relationships between the funders and providers.
International and Australian evidence shows that such reforms can both free
more resources for health care delivery and make accountability clearer and
more focused on health outcomes. Sorting out the roles of Commonwealth
and state health authorities would also be of benefit.”
CRCAH executive officer Mick Gooda said it was paradoxical that the very
methods used to fund Aboriginal comprehensive primary health care were
actually impeding their ability to deliver the best possible service.
“The solutions to Aboriginal health lie not just in better pills and technology but
in removing obstacles to Aboriginal and Torres Strait Islander peoples
accessing the most effective health care possible,” said Mick Gooda. “This
research points to one obstacle and we are confident that governments will
read the report, take note and seek to reform the funding systems for
ACCHSs.
“We are certainly not advocating a reduction in financial accountability for
these medical services, indeed we strongly support such accountability, but it
is counterproductive that these accountability requirements actually work
against the very efficiency of the health service.
“It makes no sense and needs reforming as a matter of urgency,” said Mick
Gooda. “We are calling on the Australian Government to undertake such a
reform as part of its broader reforms arising from the National Health &
Hospital Reform Commission’s recommendations.”
Launch of the Overburden Report
Mr Tom Calma, Aboriginal and Torres Strait Islander Social Justice
Commissioner
Australian Institute of Aboriginal & Torres Strait Islander Studies
Acton, Canberra
12.45 PM August 17 2009
For further information:
Alastair Harris CRCAH Communications - 0409 658 177
Note: Overburden is a mining industry term, used to refer to the soil, rock and other
materials that must
be removed to get to the ore. It is
used here to mean the
administrative work that has to be done by providers and funders to allocate, acquire,
manage, report on, and account for funding and the services and other activities it was
used for. These are overhead expenses, and should be kept to a minimum.
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