It is publicly accepted that prisoner health care services are inferior to what is offered to the general public. This is a consequence of prisoners being excluded from Medicare due to s19(2) of the Health Insurance Act 1973 (Cth), which prevents health services receiving funding from Medicare where a State or Territory is already providing the service.
The Commonwealth Health Minister can grant an exemption where the exclusion results in disadvantage. Due to the demonstrable health inequities that prisoners experience, there is a clear case for some health services to be exempted from the exclusion. We outline some targeted Medicare items that if funded for people in prison, could address some of the most common unmet health needs.
This proposal is supported by arguments from NSW State Coroner Joan Baptie, NSW Inspector of Custodial Services Fiona Rafter, the Australian Medical Association, Public Health Association of Australia, Royal Australian College of General Practitioners and others. In the recent inquest into the death of an Aboriginal man in prison, Baptie recommended: “That JHFMHN should continue its work advocating for a trial for access to Medicare for Aboriginal inmates.“ (p. 3)
Aboriginal and Torres Strait Islander (ATSI) people experience worse health than non-Indigenous people, including mental health and substance use in 65% of ATSI people. Indigenous people are vastly overrepresented in prison and experience higher rates of chronic diseases and deaths in custody.
Culturally appropriate healthcare services are not offered to ATSI prisoners. Additionally, all psychological services have a clear conflict of interest, where the psychologist is presented as a trusted counsellor but also makes decisions regarding classification and release. In effect, neither of these essential services are currently available.
We suggest that the Commonwealth Health Minister grant exemptions for the following to be funded in prisons:
- MBS Item 715 Aboriginal and Torres Strait Islander Peoples Health Assessment.
- All MBS items related to the Better Access Initiative for psychological services.
To carry this out and meet the needs of prisoners we propose the use of eHealth through computer tablets which are already in prison cells in NSW and to be delivered nationally. eHealth is an important resource due to:
- The physical restrictions in delivering appropriate health services in prison.
- The conflict of interest in current mental health services in prison.
- The ability to provide quality care through audio and video communication.