Sustainable Funding Domain
CREATE is undertaking three projects within the Sustainable Funding Domain to respond to this sector-identified knowledge gap. Projects 1 and 2 will utilise primary research methods and economic modelling, while Project 3 will use systematic reviews linked with various evidence translation activities.
Project 1 – Making the Medical Benefits Schedule Work for the Aboriginal Health Sector
The focus of Project One is on generating evidence and tools that will ensure that the Commonwealth policy of increasing Medical Benefits Schedule (MBS) rebates as a revenue source for the sector will increase the sector’s capacity to provide comprehensive primary care. It aims to achieve this by looking at options to improve billing rates, establish new MBS items and develop evidence of the gap between MBS rebates and the costs of providing care in Aboriginal Community Controlled Health Services (ACCHSs). Tools developed for the Aboriginal and Torres Strait Islander Health Sector will be an output. The questions to be addressed are:
- Given the existing MBS schedule, what factors facilitate and generate barriers to billing the MBS for services for which there is an MBS item?
- In the case of the Practice Incentive Payment Indigenous Health Incentive (PIP IHI), and the associated chronic disease management items: what is the relationship between the costs of provision and the MBS revenue received for these items? How does this differ between mainstream and the Aboriginal Health Sector and across ACCHSs?
- For services that are provided by ACCHSs but do not have a corresponding MBS item number how can ACCHSs work to develop a Medical Services Advisory Committee application based on routine data collection and existing economic evaluations of services?
- What do the findings of the research suggest about the strengths and the limitations of MBS revenue as a source of funding for Aboriginal Community Controlled Health Services?
Consultation with the sector, literature reviews and economic modelling methods will be used in this research.
If you have any questions or would like further information about this project, please contact Dr Carol Davy at [email protected].
Project 2 – How Much and Where Does It All Go? Expenditure and Funding
Aboriginal and Torres Strait Islander health expenditure has increased over the last ten years, but is this increase due to improved identification of expenditure, higher costs of service delivery or more services for Aboriginal and Torres Strait Islander people? For example, the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes (NPA) (States) and Indigenous Chronic Disease Package (ICDP) (Commonwealth) involved a commitment of $1.6B in expenditure over 4 years on chronic disease – but was this rebadged or new funding? This project will provide tools and evidence for the Aboriginal and Torres Strait Islander Health Sector to respond critically to government statements about current and increasing government expenditure, particularly in the context of negotiations about ongoing funding. The questions to be addressed are:
- What are the drivers of change in expenditure on and funding of Aboriginal and Torres Strait Islander health?
- How has the evidence of changes in expenditure, and comparisons with mainstream, been used in the policy narrative? And how has this changed over time?
- What is the relationship between government policy (e.g. ICDP) and expenditure and funding?
This project will involve: consulting with the sector, reviewing expenditure and funding reports such as the Australian Institute of Health and Welfare (AIHW), identifying the technical issues around reporting expenditure, reviewing expenditure commitments to ICDP and the NPA under Close the Gap and other health initiatives, and tracking the narrative around expenditure on Aboriginal and Torres Strait Islander health expenditure.
If you have any questions or would like further information on this project, please contact Dr Carol Davy at [email protected].
Project 3 – Evidence Reviews to Understand the Value, Effects and Financing of Aboriginal Community Controlled Health Services
The first objective of this project is to conduct three segregated evidence reviews which sequentially identify, critically appraise and synthesise the following evidence:
- Qualitative evidence regarding what Aboriginal and Torres Strait Islander peoples value or seek in a primary health care service and how they experience primary health care provided by Aboriginal and Community Controlled Health Services as uniquely valuable or challenging;
- Quantitative evidence measuring the effects of primary health care provided by Aboriginal Community Controlled Health Services on Aboriginal and Torres Strait Islander peoples’ access to appropriate and affordable health care, health status and the social determinants of health; and
- Mixed methods (qualitative and quantitative) evidence related to the financing of Aboriginal Community Controlled Health Services, including funding challenges and financing mechanism strengths/weaknesses, costs/unique costs, costs relative to revenue, and options for enhancing efficiency (decreasing costs whilst enhancing or maintaining effectiveness.
The second objective is to use the findings from the three reviews to summarise knowledge and knowledge gaps to answer the question: How is primary health care provided by Aboriginal Community Controlled Health Services uniquely valuable and challenging?
The third objective is to use the findings from the evidence synthesis to:
- Make recommendations to government decision makers working on policy, funding and service delivery reform in the Aboriginal primary health sector;
- Draw inferences for health care practitioners involved in primary health care provision for Aboriginal and Torres Strait Islander peoples;
- Identify research priorities for researchers committed to building the evidence required to support optimal resource allocation in the Aboriginal Health Sector and to support the health of Aboriginal and Torres Strait Islander peoples.
The research will be followed by an implementation phase in which tools will be developed and disseminated to translate the research findings into better policy, more funding and better health practice in the Aboriginal health sector. Representatives from the CREATE Leadership Group are working together with the team of reviewers to ensure that unwritten knowledge specific to the sector is incorporated into the finding and recommendations for this project.
To obtain further information about this project, please contact Dr Dr Carol Davy at [email protected].