What's locking Australians out of healthcare?

31 October 2024

The cost of living crisis has many faces: grocery prices, energy bills, rents and mortgages, but few portray such a human cost as the impact on health.

Our Access Denied: Australians Locked Out of Quality Healthcare, report released last week shows that rising costs are having a material impact on people’s capacity to seek support from GPs, dentists and specialists.

Working with researchers at the University of Canberra, with a fresh analysis of data collected by the ABS, the report is both a snapshot of the state of health services across the state and a harbinger of the long tail of financial stress.

The research also highlights the cost of these failings, with one in four attending an Emergency Department because they could not access a GP. This shows the way bad planning burns public money.

The results are sobering for anyone concerned about the lives of people already doing it tough:
A massive 250 per cent surge in patients who delayed or didn’t see a doctor due to cost (one in ten of all respondents).
The impact of these pressures is especially stark in regional areas, where 15 per cent are delaying this basic support.
Nearly half of patients felt GPs did not spend enough time with them. In regional areas, there was a 63 per cent increase in those experiencing this care deficit.
A 25 per cent increase in the number of NSW patients delaying or not seeing a dentist due to cost, with nearly a third of people in regional NSW putting dental work on hold.

Dig deeper and those numbers come to life in confronting ways. Dr Anthony Brown from Health Consumers NSW says the stories they are hearing on the ground is of people having to make increasingly tough choices with limited money.

“People are making really tough choices about what to spend on money this week. Do I pay for petrol to get to work or fill a prescription? Is this the week I pay the rent or is this the week I see my GP?” Anthony says.

“We are seeing an increase in the number of people talking to us about being in that circumstance who never thought they would be here,” he says. “They have jobs but they are just hanging on, only one life event away from disaster.”

The pressure on people who are not only struggling but caring for others, either kids or parents is particularly stark, with the flow-on impact of these impossible choices where there is the need for more costly interventions that undermine their ability to care for others.

These hard choices are impacting on people’s mental health; it’s natural people deal with the most pressing commitment, but it leads to a state of constant stress.

“It is this domino effect of the hard choices that creates a cascading caring deficit,” Anthony says. “And the reality is this puts greater pressure on scarce government services.”

We learned during the pandemic how critical these on-the-ground feedback loops are when delivering services in a crisis. NCOSS members stepped up to give government the best view of community need.

But this report shows how we can also leverage our trusted relationship on the ground to identify challenges; and propose solutions that are practical, targeted and, critically, deliverable.

This is no magic wand, instead a series of systemic interventions that all rely on each other to make the system work for those who rely on it the most.

Increase income support so people can afford to get the basic care they need.
Support and expand bulk billing to improve affordability and reduce out-of-pocket costs, particularly for vulnerable populations and those with complex medical issues.
Recognise oral health is a universal need and support it accordingly.
Improve healthcare access and availability in regional areas, with more facilities and better transport, especially for those without cars.

As the AMA says, our health care system is a sick care system. Now that we have a compelling evidence base, the acid is really on all of us to demand all levels of government put these pieces together.

P.S. If you want to know more about these issues, here a few reports that I found useful:

A New Medicare: Strengthening General Practice — really clear and digestible report on GPs and how to make it easier for people to access it.

How to Fix Australia’s Broken Health System — this is old but still relevant.

The Social Determinants of Health — this is a great reminder that so much about health relates to issues that have nothing to do with medical appointments and much more to do with issues that are directly relevant to the work of the social services.

NCOSS spoke to Health Consumers NSW CEO Dr Anthony Brown about advocating for affordable health care.

Tell us a bit about your professional journey?

After university, I worked as a volunteer coordinator for the St. Vincent de Paul society — I thought I’d do this for a couple of years and then get a ‘real job’. Thirty five years later I’m still working in the community sector! I've worked for different community and consumer organisations, as well as at the Male Health Centre at Western Sydney University. This is where my interest in collaborating with patients and carers in designing better health services really developed — and where I completed a PhD looking at retired men’s engagement with their communities.

What is the biggest impact of cost of living pressure you are seeing

People talk to us at Health Consumers NSW about the difficulties in finding affordable health care. There are fewer and fewer bulk billing GPs and more and more people are being forced to make decisions about paying for health care, or other expenses.

How are you dealing with this though your service?

This is a real challenge for us. Because we work at systemic advocacy, we want to know about the difficulties people experience with the health system, but there is not a lot we can do to help individuals. We would like to see more individual advocacy for people who use health services, to help people find their way through the complex health system.

Tell us a good news story about your work

We were very involved, together with other states and territories consumer peaks, in raising awareness about women who had been injured by surgical mesh. It was very rewarding to work with local women and help broker introductions to key people in the health system. And then provide training and support to them as they worked with to co-design new policies and services.

What’s one thing you’d change about service delivery?

Services are always better when the people who use them have a say in what they look like and how they are run. I would like to see more services designed in collaboration with their clients and users, and more creative ways to involve consumers and end users in governance.

A new report launched by NCOSS last week has found that a rising number of people in NSW are delaying healthcare because of the cost.

There is a serious problem when 1 in 5 people can’t afford to see the dentist and 1 in 10 can’t see their GP.

Our research shows that people living in regional NSW are the most likely to be impacted, and that it is typically worse for single parents, families, older people, and those on low incomes.

It also shows the clear impact these pressures have on NSW emergency departments – 1 in 4 patients visited emergency because their GP was unavailable.

READ OUR NEW REPORT — Access Denied:

Australians Locked Out of Quality Healthcare

We have prepared a key insights report summarising the research, accompanied by factsheets with results for regions across NSW.

You can see how your region compares by using our online mapping tool. It shows detailed patient experience results on a local level.

We are urging the state and federal governments to make changes such as:

Raising the rate of income support
Improving bulk billing
Increasing funding for the public dental system
Providing better regional transport options for people needing to travel for healthcare.

If you would like to discuss this research with us or share how these experiences impact your organisation and/or client, please email advocacy@ncoss.org.au.

The 2024 NCOSS AGM will be Friday, 15 November on the part of Gadigal Country now also known as Yirranma Place, 262 Liverpool Street, Darlinghurst and by livestream.

We’re very excited to announce that our keynote speaker is Dr Rebecca Hartley, author of a number of books — including most recently, Sassafras: A memoir of love, loss and MDMA therapy — and one of Australia’s foremost researchers on social trends. We’re also thrilled that we’ll be joined by Winnie Dunn, the first Tongan-Australian woman to publish a novel in Australia — the critically acclaimed Dirt Poor Islanders — and General Manager of the Sweatshop Literacy Movement.

You can order signed copies of their works and collect at the AGM or we can post them to you. Anthologies from emerging Sweatshop Literacy Movement writers, edited by Winnie, are also available for order. A limited number of copies will be available for sale on the day, so don’t miss out. They’d make fantastic Christmas presents!

We’ll also hear from Peter Lewis, Executive Director of Essential Media, Cara Varian, NCOSS CEO, and John Robertson, CEO of Foodbank NSW & ACT and NCOSS Board President.

For those able to attend, in-person, a light lunch will be served after the event to give us a chance to catch up. Be quick to register — places are limited.

For those who can’t, just before we break for lunch, we’ll be drawing the winners of our lucky door prizes. To be in the draw, you’ll need to be an NCOSS member and be registered by 13:00 (1:00pm) on Wednesday, 13 November 2024.

Culturally Responsive Trauma Informed Practice
Yamurrah
4–5 & 14–15 November, Newcastle
$1200–$1700 | Register here

This training will give you foundations for working within a culturally responsive trauma informed framework.

You will walk away from this training with:

Knowing why and how to provide trauma informed care in a culturally responsive way.
A good balance of theory, current context and frameworks to support your practice.
An understanding of how to design your service and provide services in ways that don’t re-traumatise people.

Aboriginal and Torres Strait Islander Employment Day
Babana
8 November, Cockatoo Island
Free | Register below

Transport will be provided by the NRMA’s Manly Fast Ferry - Departing at Eastern Pontoon, Circular Quay at 10am sharp - Returning at 2:30pm.

Free community event (lunch included) to discuss connected employers and job hunters, providing networking opportunities, employment provider support and training as well as mentoring opportunities for the First Nations’ community.

Contact Mark at success@babana.org.au or 0411 282 917.

Understanding DFV Perpetrated Against People and Animals
Lucy's Project
11 November, Online
Free | Register here

Lucy’s Project works to improve access to services for people and animals experiencing domestic and family violence.

There are three topics on offer, which will be delivered over November to January.

Session 1: Understanding DFV perpetrated against people and animals

Session 2: Providing animal inclusive intake, risk assessment and safety planning

Session 3: Implementing animal inclusive practice and legal issues to consider.

From the Ground Up: Growing Emergency Preparedness
Collaborating 4 Inclusion

13 November, West HQ
Free | Register here

Hosted by the NSW Reconstruction Authority in partnership with Collaborating4Inclusion, this workshop will share practical tips and nationally adopted Person-Centred Emergency Preparedness tools to build agency and resilience in priority populations and increase their inclusion and participation in emergency management practice and policy.

Service providers will get the chance to trial a new tool for self-assessing their organisation’s emergency preparedness and continuity planning and learn more about flood risk in the Hawkesbury-Nepean Valley.

Pride Foundation Australia Small Grants
Closing Date: 18 November 2024

The Small Grants program supports projects proposed by individuals and or organisations and or communities who would otherwise be limited by the constraints of other funding programs.

The maximum grant has been increased to $1000 in 2022 and there will be more grants awarded (if successful) each round. The project needs to directly or indirectly assist, involve and benefit LGBTQIA+ people and promote positive social outcomes and mental health in the community.

For more information, please visit the grant information page.

Financial Wellbeing and Capability Activity
Closing Date: 2 December 2024

Grant opportunities for programs delivered through the Financial Wellbeing and Capability (FWC) Activity are now open for application, for new 5-year grants from 1 July 2025 to 30 June 2030.

Grant opportunities for the following programs are available at GrantConnect:

Some of the latest from our Jobs Board:

Official Community Visitor (NSW-wide) - Ageing and Disability Commission - VIEW JOB

Communications Lead (Sydney CBD) - LGBTIQ+ Health Australia - VIEW JOB

Community Engagement Officer (Sydney CBD) - Energy & Water Ombudsman NSW - VIEW JOB

AOD Community Service Worker (Inner West Sydney) - WHOS - VIEW JOB

Team Leader – LGBTQ+ Women’s Health Programs (Sydney CBD) - ACON - VIEW JOB

Project Officer HepLink NSW (Inner West Sydney) - Hepatitis NSW - VIEW JOB

Communications Lead (Sydney CBD) - LGBTIQ+ Health Australia - VIEW JOB

NCOSS gives its members the opportunity to share their stories, research, resources, events and more through NCOSS eNews. If you have something to share with the sector, send through a short blurb (50-70 words), image (250 x 250px) and relevant links to info@ncoss.org.au.

We will endeavour to add it to an edition of NCOSS e-News (goes out every fortnight on Thursday morning). Deadline for content is 5:00pm on Monday, the week of publication. The next deadline is Monday, 11 November 2024.