A survey of 417 low-income residents of NSW has found that a ‘quality health system’ is the main issue they want the State Government to take action on, with affordable dental care to be given top budgetary priority.
Almost 50 per cent of regional respondents cited cost as the major barrier to improving their health, while dental treatment, unaffordable for 38 per cent of interviewees, was the number-one ‘cannot afford’ item in a list that included decent housing, medical treatment and prescribed medication.
According to the AIHW, “The affordability of oral health care has both personal and system-wide implications, with dental conditions the third highest reason for acute preventable hospital admissions in Australia.”
Poor Health: The Cost of Living in NSW, the report based on the survey was released by the NSW Council of Social Service this week. NCOSS works with and for people experiencing poverty and disadvantage to see positive change in communities.
Interviewees included recipients of the Age or Disability Support Pension, a Carer Allowance, Newstart, people receiving a parenting payment, and families with dependent children.
“The high and growing cost of health is having a very real impact on people experiencing or at risk of poverty and their families across NSW,” said CEO Tracy Howe.
“The cost of things like GPs who don’t bulk bill, allied health treatment, and over-the-counter medicines are increasingly out of reach for people on low incomes”
“There is plenty of research highlighting the negative health outcomes that low-income people experience as a result of being unable to meet growing health costs. But we wanted to… [also] hear directly from people experiencing or at risk of poverty about their experiences and what would make a real difference in their lives.”
Ms Howe added that people on low incomes – of whom there is a disproportionate number in regional areas, including the Northern Rivers - are less likely to eat well, more likely to be overweight or obese, and less likely to participate in physical activity.
“They are more likely to experience a broad range of chronic health conditions, such as arthritis, kidney disease, diabetes, heart disease, stroke, poor oral health and some cancers,” she said.
The report noted that Australians pay more out of their own pockets for health treatment than most other OECD countries, and the cost of health care in NSW has risen by just over twice the rate of CPI over the last ten years: “The cost of things like GPs who don’t bulk bill, allied health treatment, and over-the-counter medicines are increasingly out of reach for people on low incomes,” it said.
The impact of affordability on accessing specialists was found to be “particularly acute”, with only 30 per cent of specialist appointments bulk-billed. In NSW the average patient contribution is $78. 24.
“People … often do not know in advance how much a service will cost… this can create stress, act as a deterrent to accessing care, and risks exposure to bill shock.”
Some 39 per cent of respondents said they could not afford appointments or sessions with allied health professionals, while 33 per cent said they could not afford counselling or other support to address depression, anxiety or other mental health concerns.
Around one-quarter of those surveyed described imaging services and other diagnostic tests as unaffordable, with imaging especially unaffordable (53 per cent) for those with dependent children.
Nearly 1-in-ten cannot afford prescription medicines, despite the subsidies, with adults who delay filling or do not fill a medical prescription due to cost ranging up to 15 per cent.
Transport to and from medical appointments was another issue, especially for regional people, with 11.5 per cent unable to afford the cost: “In NSW, patient travel subsidies recognise this to some extent, but do not cover all modes, including hire cars and community transport. People who have no option but to use these modes of transport – usually because they have limited mobility, do not have access to a car, or live in areas with no public transport – can end up paying significantly more in order to access healthcare.”
Almost half of the survey respondents could not afford private health insurance, while 14.4 per cent were unable to afford food for a balanced diet. Activities or equipment such as sport, gym membership, swimming, cycling were unaffordable for many people, a matter of concern “when we also know that less than half (45 per cent) of people in the lowest income quintile have participated in sport or physical activity within the last year, compared to 80 per cent in the most advantaged quintile.”
NCOSS said that while all levels of government play a role in ensuring access to appropriate health supports, its focus is on what the NSW Government can do to minimise affordability barriers to good health and improve the health outcomes of vulnerable people.
Summarised, the report’s recommendations are:-
- Increase access to timely and affordable dental care for people on low incomes.
- Invest in communication efforts to ensure all families are aware of the dental health services available for their children.
- Increase the availability and affordability of community mental health services, including through implementation of Living Well: A strategic Plan for Mental Health in NSW 2014-2024.
- Further investigate transport as a barrier to accessing health care with a view to increasing investment in health transport.
- Increase investment in onsite accommodation and carer-friendly wards in order to enable the important role that carers play in the health care of hospital patients.
- Efforts to improve people’s diets, particularly current responses to the NSW Premier’s commitment to reduce overweight and obesity rates in children, should take affordability barriers into account.
- Strategies aiming to increase the participation rates of under-represented groups in organised sport must recognise that cost (including the cost of transport) is an important barrier to participation and work to address this.
