Here's a recipe for a more equitable health care system in Australia

Not only does this say something about the inadequate funding of this Aboriginal medical service but also about the inequitable distribution of power over resource allocation in health care. It is also an example of institutionalised racism. This has been defined as "the collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture or ethnic origin".

Defining health care equity

There is no agreed correct definition of equity in health care. Equity is inevitably a value-laden, social and cultural phenomenon.

The most common definitions are equal health, equal access (for equal need) and equal use (for equal need).

There are also different ways of conceiving of equity. For example, horizontal equity is about the equal treatment of equals, while vertical equity is about the unequal but equitable treatment of unequals.

How to define equity is perhaps best decided on an informed basis by the Australian community as a whole. To date they have had little chance to do so. One example, that at least starts down this road, is the equity stance that citizens' juries adopted at a meeting organised by the WA Medical Council:

Equal access for equal need, where equality of access means that two or more groups face barriers of the same height and where the judgment of the heights is made by each group for their own group; where need is defined as capacity to benefit; and where nominally equal benefits may be weighted according to social preferences such that the benefits to more disadvantaged groups may have a higher weight attached to them than those to the better off.

However, this implies that all groupings, social and cultural, have the same construct of health, a common presumption in definitions of equity. Yet, even within Australia, the construct of health is different for Aboriginal people from that of non-Aboriginal Australians. Distributive justice in health care, however, requires measured outcomes or consequences, involving health or health need. If there is no common outcome, operationalising distributive justice becomes problematical.

Some key inequity issues

Lack of political will and complacency

If progress is to be made in achieving more equitable health care, there needs first to be the political will to do so; reduced complacency surrounding the idea that Medicare, the publicly funded health insurance system, is already fair; and research to allow greater understanding of some of these issues.

The most glaring examples of lack of political will of late are the government's schemes to promote greater uptake of private health insurance and subsequent use of the private sector. These are symptomatic of a desire to work against equity in health care.

Second, there is unfortunately a belief that we already have an equitable health care system. There is a perception that Medicare is universal and fair (as in the Friends of Medicare slogan "It works. It's fair. It's Medicare"). Even if that were the original intent, Medicare today is, in reality, neither. The mistaken belief that it is fosters complacency about equity in our health care system as a whole. Medicare has in principle universal coverage; it is fair. In practice, for primary care services, this turns out not to be true. On average, Australians use Medicare-funded primary health care to a value of just over $530 per year. The people in Double Bay, a rich suburb in Sydney, use more than $900.

The Aboriginal people of the Kutjungka Region, in the Kimberley, are among the sickest in Australia,. They use less than $80 in Medicare primary health care funds per year, largely because of the non-availability of GPs. (Initiatives such as the Primary Health Care Access Program being trialed in the Northern Territory may help on this front.)