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Perceptions of Services

The task of providing health services in the interior and isolated areas of Australia is formidable because of enormous distances, small populations, an urban-trained work-force with little experience in such settings, and rising expectations among rural folk for improving health care (Brownlea and McDonald 1981). The rapidly growing non-Aboriginal urban population in the centre of the continent, focused on Alice, also has high expectations of medical services because most new settlers came from urban environments, and indeed from metropolitan environments, especially Adelaide. At the same time, the Aboriginal population, largely living in fringe camps, public housing, and hostels in the town (Burnley and Parkes, chapter 3), and non-urban settlements and camps in the hinterland, has a very different relationship with health authorities and perhaps more significantly, different expectations of adequacy of service and, indeed, of longevity. The overall life expectancy at birth of Aboriginal people is still almost 20 years below that of the non-Aboriginal Australian population, although there have been distinct improvements in infant mortality in the 1970s.

The pattern of health service establishment in Alice Springs differs from that in many country towns of similar size in the east, south, and west of the continent. ln 1980, at the time of the survey in Alice Springs, there was only one general practitioner in the town in addition to the medical doctor and nursing support staff in the Aboriginal Congress, and some 35 doctors, many with post-graduate training, working for the hostpial. Not unexpectedly, much primary medical care normally given by private medical doctors, or community medical centres in some states, is given directly by the hospital, more especially its out-patient and casualty section. Visiting nurses and the Royal Australian Flying Doctor Service bring help to more isolated settlements, camps, stations, and outstations (see figure 2.5)

Views of Health Service Adequacy

In the August 1980 sample survey, persons were asked a set of questions about their recent experience of chronic and short-term illness and the adequacy of treatment they had received. Sixty-three people had illnesses of more than fourmonths' duration, or 16 per cent of the sample, and another 20 had experienced short-term sickness. The proportion experiencing chronic illness was lower than the national average, in part because of the relative youthfulness of the population (New South Wales Health Commission 1974; Australian Bureau of Statistics 1980), Another influence may be that the European Alice Springs population, being largely drawn from migration, is healthier overall because of a natural selectivity with migration streams; healthy people are more likely to migrate than persons with illnesses. The incidence of respiratory illness, however, was higher than the national or New South Wales averages, and as shown below, the incidences of some respiratory illnesses were very high among the admissions to the Alice Springs hospital.

In table 8.10 type of illness is cross-classified by adequacy of treatment as considered by the interviewees. Sixty per cent thought that their treatment was adequate. However, among those with arthritis, back pain, and cerebral disorders, the majority considered their treatment inadequate.

TABLE 8.12. Adequacy of Treatment by Type of Treatment, 1980

Type of treatment Adequate treatment Inadequate treatment Total treatment types
General practitioner 8 4 12
Specialist 3 - 3
Hospital as in-patient 2 - 2
Hospital as out-patient 11 13 24
General practitioner, specialist and hospital as out-patient 7 7 14
General practitioner, specialist and hospital as in-patient 2 2 4
Hospital as in-patient and out-patient 4 2 6
More than three treatment types 8 2 10
General practitioner and specialist 2 1 3
Others 3 2 5
Total 50 33 83

Source: Sample Survey, August 1980.

Of those with arthritis and back pain, three spent a considerable time waiting at the out-patient section of the hospital; two complained of the lack of a specialist and of the lack of a private doctor. Of those with respiratory disorders and who considered their care was inadequate, four mentioned the waiting time at the hospital and the other the lack of a private doctor.

In table 8.11 the problems are listed of people who stated they had been ill and of others who, while stating they were of good health, nevertheless commented on the availability of services. The table contains frequencies of responses, rather than of persons. Fifty-seven, or 34 per cent of the responses, were concerned with the long waiting time in the out-patient section of the hospital; 29 per cent with the lack of a private doctor in the town; and 16 per cent with the poor quality of medical practitioners. The lack of a specialist and the unavailability of help after hours (home visits) were also of some importance.

Persons were asked what types of treatment they had when they were ill, and these persons are classified in table 8.12 by treatment type and also by perceived adequacy of the treatment. Almost 29 per cent of those who had been ill had their care exclusively at the out-patient department at the hospital and another 17 per cent used the out-patient section as well as a specialist and a general practitioner. Over half of all those who had been ill, both with short-term and chronic illnesses, made use of the out-patient department.

While the majority of those who had been ill were satisfied with their treatment, this was not the case with those who attended the out-patient section; 54 per cent were dissatisfied, and long waiting time was the principal criticism. The small number who were treated as in-patients were in general satisfied. The table also shows that the general practitioner only treated a small proportion of the illnesses, both short-term and chronic.

Table 8.13 indicates the mode of treatment before and after migration for those persons with chronic illnesses before migration: 33 per cent of those who were chronically ill and who had migrated had been ill before migration. Two-thirds developed ailments in Alice Springs. It will be noted that of the 12 who had their care from private general practitioners before migration, only two were exclusively doing so in Alice Springs, four obtained their care from the out-patient section of the hospital, and another four from the out-patient section plus clinic (specialist) and the general practitioner. Two of the hospital specialists maintained a part-time practice in the town.

Persons were also asked whether they had medical insurance coverage and these responses are cross-tabulated by occupational status, age, and sex in tables 8.14 and 8.15. It can be seen that only 44 per cent were insured, either privately or in the Federal Government's Medibank scheme. Because of the hospital's out-patient facilities and also because of the relative youth of the predominantly migratory population, many persons were prepared to risk not being insured. The out-patient facilities were free in Australian hospitals at the time. The tables show, however, that unlike the national trend, there were no significant differences between age or occupational status groups in the proportions insured.

In mid-1981, the Federal Government ended free out-patient services, except for certifiably disadvantaged persons, thereby forcing persons to join a medical insurance scheme. Presumably many of the high proportion of uninsured in Alice Springs would have taken steps to get coverage, but as pointed out earlier,'private medical care is in extremely short supply in the town. Many of the Aboriginal population chapter 9) would qualify at least in part on the grounds of disadvantage {unemployment and low or no income), but there was still an ambiguity in defining eligible categories for subsidized or free care.

TABLE 8.13. Type of Treatment before and after Migration to Alice Springs: Persons with Chronic Illnesses before Migration

Treatment before migration Treatment in Alice Springs
Private general practitioner Clinic specialist Hospital as in-patient Hospital as out-patient General practitioner, clinic and hospital out patient Total
Private general practitioner 2 1 1 4 4 12
Clinic (specialist) 1 1 - - - 2
Hospital - - - 1 - 1
General practitioner, clinic and hospital - - - 1 2 3
Clinic and hospital 1 - 1 - 1 3
Doctor and hospital - - - - 2 2
Other and not stated 1 1 - 1 3 6
Total 5 3 2 7 12 29

Source: Sample Survey, August 1980.

TABLE 8.14. Medical Insurance Coverage by Occupational Status of Respondents

Occupation Males Females
Insurance cover No insurance Other and not stated Insurance cover No insurance Other and not stated
Professional, technical 20 19 2 11 12 2
Administrative, executive 9 10 - 7 1  
Clerical, sales 17 5 - 22 20 2
Skilled tradesmen 21 26 2 2 2  
Semi-skilled, unskilled            
workers 13 14 1 14 13 4
Not in work-force 6 5 - 38 50 7
Unemployed - - 1 - 3  
Other and not stated 3 4 - 1 4 -
Total 89 83 6 95 105 15

Source: Sample Survey, August 1980.

TABLE 8.15. Medical Insurance Coverage by Age and Sex of Respondents

  Insurance No insurance Other and not stated
Age group Males Females Males Females Males Females
16-20 2 3 4 7 - 3
20-24 6 11 10 19 - 2
25-29 10 25 20 27 1 1
30-34 23 24 9 18 3 2
35-39 12 15 17 13 1 1
40-44 14 6 8 2 - -
45-49 6 6 3 8 - 1
50-54 5 2 5 5 - 1
55-59 3 - 2 1 - 1
60+ 8 3 5 5 1 3
Total 89 95 83 105 6 15

Source: Sample Survey, August 1980.

The medical insurance in any case will not fully cover the new cost for out-patient services which, except for Queensland which has a free hospital system, ranged between A$15 and $20 per visit in the various Australian states in June 1982. The demand for private primary medical care in Alice Springs may well increase on economic grounds; it certainly will do so as the population of the town continues to grow at a rapid rate.

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