Background
North Coast Aboriginal Corporation for Community Health (NCACCH) is an Aboriginal community controlled health organisation funded by the Australian Government Department of Health & Ageing through the Office of Aboriginal & Torres Strait islander Health (OATSIH). The role of NCACCH is to fill the gap between existing mainstream health services and identified health needs for the indigenous population residing in the Sunshine Coast & Gympie regions of Queensland.
NCACCH incorporated in 1997 and was funded in the same year after much lobbying from concerned members in the community for culturally specific health services to be provided to people. The traditional aboriginal medical service (AMS) model was favoured and implemented in 1997/98. This model proved to be inadequate for this community. Members expressed concern about issues such as service availability and access, employment of suitable workers and the management of the service.
A second model of contracting out to another aboriginal organisation located in one specific location was tried and after two (2) years this contract was not renewed by NCACCH as services were not adequately being managed or delivered to those people in need. People still had to travel too far and were still not receiving the primary health care they needed.
In 2002 the NCACCH board and staff embarked on a capacity building and professional development process. Over the next 18 months the "NCACCH Brokerage Model" evolved out of these workshops. This model utilises many different mainstream health service providers across the NCACCH region and provides Indigenous clients with a choice of who they want to access to address their health needs and where they can access those services.
Program Description
A survey was conducted in the Indigenous community to determine priorities in health needs. Identified health needs included oral health, mental health, access to GPs, diabetes and nutrition education, men's and women's health and podiatry.
To address the diversity of the needs and the geographic range of NCACCH clients, the Board determined that the best possible use of funds could be made by providing access to existing mainstream health services. The majority of services needed existed across the region within established practices. Indigenous clients just lacked the capacity and opportunity to access those services. As a result, health service providers were invited to tender to be screened for inclusion on a NCACCH Service Provider Listing. These providers of primary health care services from around the region are then contracted to provide services to meet these identified priority needs.
In order for the individuals to gain access to these services Indigenous "Referrers" were sought from the community and contracted on a voluntary basis to assist people in accessing primary health care services.
Most of the NCACCH Referrers are Indigenous individuals who work in service delivery to Aboriginal people and have strong cultural connections in the community. The Referrers come mainly from workplaces such as other Aboriginal organisations, Centrelink, Queensland Health, Mission Australia as well as self-employed people from all around the regions.
Referrers provide clients with information about NCACCH, service providers and how the client can access services at no cost. The role of the Referrers is to provide a strong cultural link to service access without influencing any individual choice about service selection.
Referrers are continually trained and updated about services and form a crucial face-to-face communication link between NCACCH and clients. The trained Referrers assist clients to complete the necessary paperwork to ensure proper management and accounting of service delivery and payments to service providers. The referral is forwarded to NCACCH where authorisation for services is faxed to the service provider. The authorisation ensures immediate access to the selected provider. NCACCH then showed a slide to showing the data to date. Another slide shows the demographic breakdown of the identified populations residing in both the regions and the number of people on the NCACCH database.
In 2003 an agreement between the Sunshine Coast Division of General Practice and NCACCH was developed whereby Indigenous people gained access to a GP of their choice at no cost to the client. Only a small percentage of doctors were bulk-billing and most Indigenous people in the community could not afford to pay the gap fee. Access to a bulk-billing doctor involved travelling long distances.
The partnership between NCACCH and the Division of General Practice generated a Health Access Card and subsequent Indigenous Health Status Database. NCACCH Health Access Cards are issued to clients upon receipt of the application form completed with a Referrer. This Health Access Card when presented with the corresponding Medicare Card gives clients access to 126 general practitioners in 26 surgeries situated across the region.
GPs who have registered with NCACCH through the Division provide a consultation free of charge to the client and collect important de-identified health data regarding the client's health status. This data is then collected and collated by the Division of General Practice and then passed on to NCACCH at a fee per consultation. NCACCH then uses this data to identify and focus on health priorities and locations.
NCACCH provides cultural awareness training to the staff at surgeries and provider offices. These sessions are brief and structured to fit into the schedule of the practice with minimal disruption to service delivery routines.
Health Outcomes
The Indigenous Health Information & Access Scheme is a program that has addressed a great need in the indigenous community and is being utilised more and more. Numeric data to substantiate improved outcomes from the program has been difficult to quantify as no database existed regarding indigenous health status prior to the program being developed. There is substantial anecdotal evidence for the following health outcomes:
• Queensland Health managers and Indigenous Health Workers report that there has been a significant reduction in Aboriginal people accessing health care through the Emergency Department at the local hospitals
• Physicians and health care workers report increased early intervention and prevention health care
• The Division of General Practice reports that more physicians are taking an active interest in Indigenous health issues
• Indigenous clients report feeling a sense of equality with mainstream society in being able to choose health care providers that suit their circumstances
• Service providers report that clients are now more likely to identify as Indigenous in accessing services which will improve data collection and validity
• Clients report that support staff at service delivery offices are becoming more culturally aware and sensitive in client interactions
• Access to primary health care is usually ensured within less than 24 hours
• The Division of General Practice reports that GPs are now able to establish long term relationships with Indigenous clients making health care more efficient and effective
• The partnership between NCACCH, the Division of General Practice, and the 2 Queensland Health Districts has focussed attention on Indigenous health for planning and decision making at all levels of the respective organisations. For example, Qld Health has made being a NCACCH Referrer a component of the position description for Indigenous health workers.
• Reducing the gap between Indigenous and non-Indigenous individuals ability to access primary health care has been seen as a positive step in community reconciliation
• NCACCH has been selected as one of the 8 finalists in the Reconciliation Australia/BHP Indigenous Governance Awards.
A very simplified perspective of the NCACCH Brokerage Model is that it endeavours to provide the equivalent of basic private health cover for primary health care without the need to pay the gap fee upfront.
Challenges
Some individuals outside the NCACCH geographical area and some other indigenous health organisations have voiced concerns that NCACCH Brokerage services are not "culturally appropriate" because they provide access to existing mainstream service providers. NCACCH has taken the position that the Brokerage Model represents the best choice to ensure maximum health outcomes with the limited budget available while ensuring client choice. The Board believes that it is up to each individual to determine whether a particular service is culturally appropriate for them or not.
Last year a client survey question was added to client documentation forms that are completed upon service delivery. Responses to date indicate a 100% satisfaction rating by all clients.
In reviewing the model against a stand alone segregated Indigenous health service the Board noted that such a service limited service provision to one service provider in one location. The following financial analysis demonstrates the effectiveness of the model in our area of service delivery.
NCACCH Board is aware of the limitations of the Brokerage Model. It would not be likely to work well in rural, remote areas where there are limited service providers. NCACCH only know that it works, and works well for this community, and is very cost efficient and effective for this organisation.
The current and pressing challenge is to find a researcher, or source of funding to engage a researcher, to analyse the data collected to date. The established data collection is de-identified to protect clients from any perceptions that confidentiality might be at risk. The de-identified data collection limits analysis in several ways. For example, it can't currently be determined if one individual was seen for a particular problem 4 times or if 4 individuals were seen once for the particular problem.
Before revising the current database and collection system, NCACCH would like to have the existing data thoroughly analysed to inform the revision. Collaboration with the partner organisations is discussing the linkages to improve the information and make it more useful for planning and decision making.
Any suggestions or assistance on accessing sound, thorough research on this type of data would be greatly appreciated. A university which would be willing to apply for an Australian Research Council Linkage Grant might be a mutually beneficial partnership. |
