Impact of COVID-19 on health services
In March 2020, measures to reduce the risk of community transmission of COVID-19, including limiting public gatherings and reducing non-essential travel, were put in place across Australia (Department of Health 2020a). The restrictions are likely to have changed the behaviour of many Australians, including the way and frequency with which people engaged with health care services.
Systemic changes that may have reduced the use of health services include:
- closure of, or restrictions in, some types of health care services (such as cancer screening, non-urgent dental care, elective surgery)
- concentration of in-hospital resources on COVID-19 wards and intensive care units when necessary
- redirection of health staff to COVID-19 testing clinics and, later, to vaccination clinics
- restrictions on who could enter health care facilities because a person had COVID-related symptoms, or was a close contact of someone with COVID-19 (including staff, visitors and potential patients)
- restricted access to interstate, urban based, or international health staff due to border closures and remote community travel restrictions.
Primary health care
Among Indigenous Australians (identified through the Voluntary Indigenous Identifier, or VII), telehealth accounted for nearly 412,800 of the 4.7 million claims for non-referred general practitioner (GP) consultations in 2019–20 (8.8%), compared with just under 3,300 claims for non-referred GP consultations by videoconference in 2018–19. The increase follows the introduction of MBS rebates for telephone consultations and the expanded eligibility for video conferencing items on or after 13 March 2020.
Impact of COVID-19 on Indigenous-specific health checks
In response to COVID-19 related restrictions, a range of temporary telehealth MBS items were made available to allow continuity of care for patients, as well as to provide protection for both patients and health care providers from the risk of COVID-19 (Department of Health 2020b). This included telehealth items for Indigenous-specific health checks, namely MBS items 92004, 92011, 92016 and 92023.
Figure HS 2 in the Indigenous-specific primary health checks subtopic shows that while the proportion of Indigenous Australians who had an Indigenous-specific health check fell in 2019–20 and 2020–21, there was an increase in health checks carried out through telehealth.
OSR data were used to examine changes in 2 aspects of service delivery/service use (client numbers, client contacts) during the first and second years of the pandemic among a subset of 161 ISPHCOs who reported to each of the 2018–19, 2019–20 and 2020–21 collections.
The number of clients receiving at least 1 service from the 161 included organisations rose from 388,118 in the 2018–19 collection to 393,146 in the 2019–20 collection, an increase of 1.3%. However, this total increase masks variation at the organisation level. There were 5 organisations with more than a 20% decrease in their client numbers (a total of around 2,200 fewer clients than in 2018–19) and 11 organisations with more than a 20% increase in their client numbers (a total increase of around 7,400 clients compared with numbers for 2018–19).
Contrasting with the findings for client numbers, recorded client contacts (excluding transport contacts) for the 160 included organisations declined between the 2018–19 and 2019–20 OSR collections, from 4.62 million to 4.53 million (a 2.0% decrease). Twelve organisations had decreases in their client contacts of more than 20% (around 158,000 fewer client contacts in total). For this same period, however, another 18 organisations increased their client contacts by more than 20% (around 93,000 more client contacts in total).
Emergency department presentations
In 2013–14, there were nearly 400,000 presentations to EDs by Indigenous Australians, a rate of 516 presentations per 1,000 Indigenous Australians (crude rate). The number of presentations grew by an average of 8.5% per year to around 589,500 in 2018–19, while the crude rate grew by an average of 6.4% per year to 704 per 1,000 in 2018–19 (the last full financial year before the pandemic). Between 2018–19 and 2019–20, the number and crude rate of ED presentations still increased (which differs from the pattern for non-Indigenous Australians), but the rate of increase was considerably smaller than in the previous years – a 4.4% increase in total presentations (to around 615,400) and a 2.4% increase in the crude rate (to 721 per 1,000). This is around 24,000 presentations fewer than expected had the previous average rate of growth applied.
This 4.4% increase in presentations for the financial year masks variability within the yearly data, which align with the implementation of the COVID-19 related public health measures starting in March 2020:
- Between 1 July 2019 and 28 February 2020, the number of ED presentations for Indigenous Australians was 45,000 higher than between 1 July 2018 and 28 February 2019.
- Between 1 March 2020 and 30 June 2020, there were more than 19,000 fewer ED presentations for Indigenous Australians than between 1 March and 30 June 2019.
In 2013–14, there were slightly more than 393,000 hospitalisations (including dialysis) for Indigenous Australians, a rate of 518 hospitalisations per 1,000. By 2018–19, there were around 556,000 hospitalisations, at a rate of 664 per 1,000. The total number of hospitalisations grew by 4.0% (to 578,000) between 2018–19 and 2019–20, while the rate grew by 2.0%.
It is important, however, to look at hospitalisations for dialysis separately from other hospitalisations. The number of hospitalisations for dialysis in 2019–20 were around 15,700 higher than in 2018–19 (an increase of 6.5%), while the crude rate increased from 288 per 1,000 to 301 (an increase of 4.5%). Analysis of average daily hospitalisations and monthly numbers of hospitalisations showed that hospitalisations for dialysis in 2019–20 were higher than those in every period during 2017–18 and 2018–19.
For hospitalisations excluding dialysis, the total number of hospitalisations grew by 2.1% in 2019–20 compared with 2018–19, and the crude rate grew by 0.2%. While the total number of hospitalisations excluding dialysis was higher in 2019–20 than in 2018–19, there were different patterns throughout the year, which coincided with the first wave of the pandemic:
- Between 1 July 2019 and 28 February 2020, the number of hospitalisations for Indigenous Australians rose by 17,000 on that for the previous year (a rise of 8.2%).
- Between 1 March 2020 and 30 June 2020, the number of hospitalisations for Indigenous Australians was more than 10,000 lower than that for March–June 2019 (a drop of 9.7%).