Use of health services

Rural women had fewer visits to general practitioners (odds ratio, OR=0.54; 95% CI, 0.48-0.61) and medical specialists (OR=0.60; 95% CI, 0.55-0.65). Vagenas D, McLaughlin D & Dobson A. Regional variation in the survival and health of older Australian women: a prospective cohort study. Australian and New Zealand Journal of Public Health, 2009; 33(2): 119-125 http://www.alswh.org.au/substudies-and-analyses/analyses?projpubid=386HYPERLINK "http://www.alswh.org.au/substudies-and-analyses/analyses?projpubid=386&projid=A208"&HYPERLINK "http://www.alswh.org.au/substudies-and-analyses/analyses?projpubid=386&projid=A208"projid=A208

People in rural and remote areas have greater levels of difficulty accessing a range of services.

Table 34: Percentage of people 15+ experiencing difficulties accessing services, 2014

 

MC

IR

OR/rem

Banks or other financial institutions

3.1

4.4

5.8

Centrelink

9.3

11.2

9.2

Disability services

0.9

1.3

0.8

Dentists

3.1

5.5

9.4

Doctors

3.7

8.2

11.7

Employment services

1.1

1.0

1.0

Family Assistance Office

1.3

1.7

1.1

Hospitals

3.5

4.6

3.7

Legal services

0.8

0.5

1.6

Medicare

2.1

2.3

4.9

Mental health services

0.9

1.6

1.2

Telecommunication services

6.0

7.5

8.9

Motor vehicle registry

1.7

2.8

3.1

Utilities providers

2.2

1.6

2.2

Housing services

1.2

1.0

1.4

Other service

0.7

1.0

0.9

Any service

22.7

30.5

32.5

Note: percentages appear to be crude.
Source: http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4159.0Main+Features12014?OpenDocument

In particular, people in rural and remote areas had difficulty accessing banks, doctors, dentists, Medicare, telecommunications and motor vehicle registration.

The percentages of people in Inner regional and Outer regional/remote areas having difficulty accessing dentists and doctors were respectively about 2 and 3 times greater than for people living in Major cities.

About 23% of people in Major cities had difficulties accessing services, compared with 31% and 33% of people in Inner regional and Outer regional/remote areas respectively.

 

Use of health services relative to need

The following from http://www.aihw.gov.au/publication-detail/?id=60129551940HYPERLINK "http://www.aihw.gov.au/publication-detail/?id=60129551940&tab=2"&HYPERLINK "http://www.aihw.gov.au/publication-detail/?id=60129551940&tab=2"tab=2

The age-standardised proportion of people who presented to a hospital with a severe heart attack (that is, a STEMI), and who had a procedure to open a blocked or narrowed artery (that is, a PCI) in 2010–13 was 46% for Indigenous Australians and 70% for non-Indigenous Australians.

Access to cardiac prevention and treatment services for Indigenous Australians varied by state and by region. For example, the proportion of Indigenous people who presented to a hospital with a STEMI and had a PCI in 2010–13 ranged from 21% in the Northern Territory to 62% in Western Australia, and from 29% in Very remote areas to 64% in Major cities.

Source: http://www.aihw.gov.au/publication-detail/?id=60129551940HYPERLINK "http://www.aihw.gov.au/publication-detail/?id=60129551940&tab=2"&HYPERLINK "http://www.aihw.gov.au/publication-detail/?id=60129551940&tab=2"tab=2 page 29.

Taking these last two paragraphs and the figure above from this source together, it starts to become clearer why the proportion of Indigenous people with STEMI but without PCI is so low at 46%? If the proportion of Indigenous people in rural and remote areas with appropriately treated STEMI increased to 64% (the Indigenous proportion in Major cities), then comparison between Indigenous and non-Indigenous would be much improved to from 46% to 64% versus 70% respectively.  In short, while other factors also play a role, something about rural and remote environments seems to be reducing the probability of appropriately treating STEMI.