Medicare change to give greater dialysis access to remote Indigenous Australians
The federal government has added dialysis services to the Medicare Benefits Schedule (MBS) to provide remote-living Aboriginal and Torres Strait Islander people better access to lifesaving treatment.
The sector has welcomed the move as a lifeline for the growing health crisis of Indigenous kidney disease, which has had to rely on private donations and fundraising to provide care because of inadequate government funding.
The renal health MBS item, amid other new additions to the scheme, means that from November, Medicare will cover some of the costs of dialysis delivered by nurses, Indigenous practitioners and Indigenous health workers in remote areas, “in a primary care setting”.
Rates of end-stage kidney disease are astronomically higher among Indigenous people and are increasing with remoteness, up to 50 times that of non-Indigenous people.
But a lack of dialysis in communities forces people to move to regional centres, which has devastating cultural impacts, as well as on health and wellbeing and survival rates.
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“This will not only save people having to come into town, which has flow-on issues, it means they can stay close to home and get the medical treatment they deserve as Australians,” the NT health minister, Natasha Fyles, said.
The health minister, Greg Hunt, said the new MBS listing would “drastically help improve health outcomes” for Indigenous Australians with kidney disease.
The new listing would provide a Medicare rebate of about $500 per treatment, which Fyles said was “reflective of the cost of delivering dialysis in very remote territory”.
Hunt and the health department would not provide any further details on the MBS item, including whether it would be capped, or what the geographical restrictions are.
Guardian Australia understands it would apply to 500 to 700 patients nationally, and at least half of those live in the Northern Territory.
The cost of delivering the varying models of remote dialysis is largely unquantified – although currently subject to study – but is understood to be more expensive than urban services.
Sarah Brown, the chief executive of Western Desert Dialysis, said it cost around $500 per dialysis treatment in remote communities across the NT, Western Australia and South Australia.
The community-controlled health organisation operates an Alice
Springs clinic, Purple House, for patients who have come in from traditional homelands, and provides dialysis in some communities and through their traveling clinic, the Purple Truck.
The organisation was established by a group of Pintupi people who raised $1m through an art auction. In recent years, Purple House has sustained its work through three-year funding agreements, one-off grants, philanthropy and art auctions.
Under a five-year health agreement with the commonwealth government, the NT government receives the nationally efficient price of about $670 per dialysis treatment, most of which were provided in urban settings at a cost of less than $500.
“We’d love the nationally efficient price, but this puts us in a much better position than we’ve ever been,” Brown said of the MBS listing. “The Purple Truck is currently out in Willowra, it’s never had a cent of government support. Now from 1 November every dialysis on the Purple Truck will attract $500.”
She said the consistent funding would mean recently or nearly completed clinics will now be able to open their doors, and donors would be less hesitant to support Purple House.
Brown said the MBS listing was a recognition of the Purple House model of community-controlled dialysis delivery.
“This is for the whole of Australia, so this is potential for people to get home to the Torres Strait Islands, to all the deepest, darkest bits of NT, Western Australia, South Australia,” she said. “This is a huge victory for those Pintupi fellas who got the knock back when they wanted community care in Kintore, so they held an auction.”
Alan Cass, national renal clinical committee and Menzies School of Health Research professor, said the MBS item was significant.
“We haven’t had a system where we could fund nurses or skilled workers to support dialysis in remote communities,” he said. “What that has meant is that the vast majority of people have had to leave their remote communities.
“We know that patients and families and communities tell us that getting access to treatment on country is a pressing imperative for patients and community.”
Asked about the disparity between the commonwealth payment to the NT government and the Medicare rebate to remote service deliverers, Cass said he expected there would be multi-level government negotiations around the implementation.
“Both levels will need to come to the party, but I think this is a really positive initiative and one that should be welcomed by all different players in the health system.”
The new MBS items are the result of recommendations by the MBS review taskforce, established by the federal government and led by clinicians, which has spent over two years reviewing the more than 5,700 items on the MBS. It has no cost savings targets.