Are some more equal than others

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Researchers have proposed a new funding model to provide prisoners with the same health care as other Australians.

Despite prisoners having some of the highest rates of mental illness and communicable diseases, Medicare exclusions mean that they are rarely able to access appropriate health services before they return to the community.

Researchers from the University of Melbourne, University of New South Wales and Griffith University found prisoners are missing out on certain treatments and medications, as they are too expensive to provide without access to Medicare.

The work, led by Professor Stuart Kinner who holds a joint appointment at Griffith University and the University of Melbourne, was published today in the Medical Journal of Australia.

Under current legislation, prisoners are excluded from Medicare, with their health care transferred to state and territory government departments.

"Prisoners in Australia experience profound health disparities relative to those who have not been incarcerated, with a disproportionate burden of mental illness, chronic and communicable diseases,'' Professor Stuart Kinner said.

"Prisons are uniquely placed to detect health problems, initiate care and promote health, and this has important health benefits for the communities to which prisoners return. But this does not always occur."

He said the current system heavily impacts Aboriginal and Torres Strait Islanders and people with mental illness, who are over-represented in prisons.

"The Medicare Health Assessment for Aboriginal and Torres Strait Islander People is designed to target the ongoing health needs of Indigenous people who experience earlier onset of chronic illnesses than non-Indigenous Australians," Prof Kinner said.

"But prisoners' Medicare exclusion means that neither prisoner health services, nor community organisations that provide health services to Aboriginal and Torres Strait Islander people in prison, can claim Medicare billing for this item.

"And despite prisoners having some of the highest rates of mental illness of any population, the Medicare exclusion means that they are rarely able to access allied mental health services."

Professor Kinner and his co-authors propose a mixed-funding approach, with cost sharing between the states and territories and the Commonwealth likely to achieve greater equity – and better outcomes – in prisoner health care.

"The Federal Health Minister has the power under the Health Insurance Act to grant an exemption that would end prisoners' exclusion from Medicare, paving for the way for rebates to be claimed for prison-based healthcare services in certain circumstances,'' he said.

"This would allow prisons to retain their existing health service delivery model but enhance service delivery through access to certain Medicare items at minimal cost.

"As an example, we estimate the cost of delivering an Indigenous-specific health assessment to each Indigenous prisoner in Australia per year would be less than 0.01% of the annual $20 billion Medicare budget. This is a drop in the ocean for the federal health budget, but would have substantial benefit for Indigenous Australians, who are 13 times more likely than non-Indigenous people to be incarcerated.

"Given that the focus of the health assessment is on disease prevention in Indigenous populations, delivering this service in prisons has strong cost-effectiveness credentials.

"Our mixed-funding model aligns with current government policy, whereby health resources can be directed to where they will be most effective in improving the health of all Australians.

"It also aligns with the position of the Australian Medical Association who recommend that prisoners should retain their entitlement to Medicare and the PBS, including their Medicare card, while in prison."

Michael Moore, CEO of the Public Health Association of Australia said it was important prisoners have the same access to healthcare as other Australians.

"This new research clearly illustrates a need for access to Medicare for prisoners. Improving health care for prisoners is also a sensible prevention strategy that will provide long-term savings for our health system".

Published in the Medical Journal of Australia earlier this month, the study was partially funded by a National Health and Medical Research Council grant.