Expert backs RACGP calls for access to specific MBS items in prison

Doug Hendrie

16/09/2019 1:21:02 PM

People who are imprisoned have unique and extensive healthcare needs – Aboriginal and Torres Strait Islander people even more so.

Prison cells
Prisoner health is public health, according to a leading expert.

People in prison do not get access to Medicare, since healthcare in prisons is provided by states and territories. 
And that fact, the RACGP believes, is widening the existing healthcare gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians.
The RACGP has launched a renewed push to grant prisoners access to specific Medicare item numbers, such as the indigenous health check (MBS item 715 – Medicare Health Assessment for Aboriginal and Torres Strait Islander People) and case conferences for people with chronic conditions.
The RACGP proposed the idea to Federal Health Minister Greg Hunt and Federal Indigenous Australians Minister Ken Wyatt in 2017.
‘This approach considers both improvements to the model of care within prison settings, and during transition back into community, as well as possible avenues for funding to support these activities. It encourages a central role for Aboriginal Community Controlled Health Services, to ensure culturally responsive care and continuity of care upon release,’ the RACGP wrote in its letter to the ministers.
But nothing came of the initial push, with Minister Wyatt understood to have pointed out the complexities of providing Medicare services through state-run prisons.
Now the RACGP is tackling the issue through the states, starting with New South Wales Health Minister Brad Hazzard, who has expressed interest in finding ways of better coordinating custodial healthcare into the wider health system.
Chair of RACGP Aboriginal and Torres Strait Islander Health, Associate Professor Peter O’Mara, told newsGP that access to the indigenous health check would be of major benefit to people in prisons.
He said providing culturally appropriate care could help ease the trauma of prison, as well as the transition back to society.
‘Minister Hazzard has a long-term interest in Aboriginal and Torres Strait Islander health. I get the strong sense he wants to set New South Wales up as an exemplar, to say to other state colleagues, “We can do this. It’s working well”,’ Associate Professor O’Mara said.  
‘If you’re a prisoner, you lose your right to Medicare. That means if an Aboriginal health service wants to provide support, they can’t bill Medicare.
‘If you’re a GP working in this space, you’d have to sacrifice a lot. You couldn’t do it full time.’

Dr-Peter-O-Mara-speaking-Hero.jpgChair of RACGP Aboriginal and Torres Strait Islander Health Faculty, Associate Professor Peter O’Mara.
Custodial health expert and GP Dr Penny Abbott has previously told newsGP that prison health is ‘chronically underfunded’.
‘[P]eople in prison, when released, will help society more if they’re not unwell,’ she said.
The RACGP’s calls to make the specific Medicare items available in prisons have been echoed by University of Western Australia custodial health expert Craig Cumming.
Mr Cumming told newsGP that prisoner health is public health.
‘My argument is that if we have a limited number of Medicare items made available to prisoners, there’s a lot of benefit. Problems that happen in prisons transfer to the community once people have been released, since very few people locked up are never getting out,’ he said.
‘That means addressing things like infectious disease and mental illness is best done in prison, as it’s very difficult to do so in the community.
‘Indigenous Australians are at a much higher risk of cardiovascular disease and diabetes. Those can be well managed if picked up at an early stage. It’s cheaper and easier to treat these issues early on.’
Mr Cumming said the difficulties in providing healthcare across jurisdictions had scuttled previous attempts to change.
‘Health ministers keep coming back to “that’s the way it is”,’ he said.
‘But this is about equity; people in prison should be having the equivalent healthcare to people outside. And, arguably, it should be much better, since there is a demonstrably higher need for healthcare in prisons.’
Mr Cummings said many states’ budgets for prisoner health are under pressure.
‘Budgets are being slashed for prisons, so they slash from their health budget,’ he said. ‘If the Commonwealth steps up, it would allow external providers to provide some of these basic primary care services.
‘We need to treat people who go to prison like anyone else. Letting people out of prison with untreated mental health issues is dangerous.
‘We know that criminal behaviour is often entwined with substance dependence, physical health problems, mental health issues or a history of trauma. Prisons are becoming the mental health asylums of the 21st century due to deregulation.’
A Department of Health spokesperson told newsGP that states and territories are ‘best placed’ to manage the health needs of prisoners.
‘It is well established that states and territories arrange for the delivery of in-prison health services by appropriately trained practitioners. Where public hospital care is required, states and territories can make informed decisions about where treatment should be provided,’ the spokesperson said.
‘It is unclear how the payment of Medicare benefits for detainees who are provided public health services would result in achieving equity in health for detainees. 
‘The more likely outcome is that public health services which are currently provided and funded by the relevant state or territory would be billed to Medicare wherever possible.’
A NSW Justice Health and Forensic Mental Health Network spokesperson told newsGP the state is ‘deeply committed’ to working with Aboriginal health services to improve the health of Aboriginal and Torres Strait Islander people in custody.
The Network has formal partnerships with two Aboriginal Community Controlled Health Organisations – Waminda, which supports Aboriginal women in custody who are returning to the NSW south coast region, and Maari Ma, which supports the transfer of care for Aboriginal inmates at Broken Hill Correctional Centre who are returning to the local community.
‘The Network works with local Aboriginal Medical Services across NSW as needed when coordinating care for Aboriginal inmates returning to the community,’ the spokesperson said.

Aboriginal and Torres Strait Islander health custodial health Medicare

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Associate Professor John Dearin   19/09/2019 12:11:21 AM

As a VMO to a maximum security prison for the past 20 years I strongly endorse the views of Professor Paul Mara and my colleague Dr Penny Abbott. Whether it is acces to Medicare or not, our prisoners of which there are in excess of 45,000 in this country need access to enhanced Primary Care services to manage chronic mental ill health , cardiovascular disease , chronic pain and diabetes. Justice Health requires enhanced funding to meet these pressing needs in our Correctional Centres to ensure that prisoners are returned to the community In excellent health. There are of course mitigating circumstances beyond the provision of medical services that reduce the prospects of prisoners accessing optimal health care whilst in custody.