Background

For additional information, refer to the annual Indigenous health checks and follow-ups report.

The Coronavirus disease 2019 (COVID‑19) is an airborne disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2). In March 2020, the first wave of COVID‑19 began in Australia and the World Health Organisation (WHO) declared a global COVID‑19 pandemic (WHO 2020). Other prominent waves were the second wave in Victoria, which started in June 2020 and peaked in August of the same year (Stobart and Duckett 2022), as well as the outbreaks associated with the Delta and Omicron strains of COVID‑19, which started in June and December 2021, respectively (ATAGI 2021, Bennett 2021).

The outbreaks have been associated with a range of regulations and mandates to reduce the spread of the disease within and from affected areas. Federal and state governments also introduced responses in other forms, such as economic stimulus packages and additional access to health services, to help the Australian population through a challenging time.

Key data considerations

This report focuses on the first two years of the COVID‑19 pandemic, 2020 and 2021, and, to a limited extent, some of the years prior for comparison. Due to the analysis being limited to the period up to December 2021, only the beginning of the wave of COVID‑19 that unfolded in Australia during the summer of 2021–‍22 is covered.

Telehealth and Aged Care items:

To reduce community transmission of COVID‑19, and to protect patients and health care providers, a number of Medicare Benefits Schedule (MBS) items were introduced when COVID‑19 first broke out in Australia. In relation to Indigenous-specific health checks, the new MBS items were:

  • Indigenous health checks available through video-conference or telephone: 92004, 92011, 92016, 92023
  • face-to-face Indigenous health checks available to people living in residential aged care facilities (RACF): 93470, 93479.

Throughout this report, the term ‘telehealth’ will be used to refer to services provided via video-conference and telephone.

Focus on numbers of health checks:

This report is mainly focused on comparisons of numbers of delivered Indigenous health checks during and before the COVID‑19 pandemic – including by delivery mode (face-to-face or telehealth). The figures show how the annual numbers of health checks have changed over time in different parts of Australia and how the month-to-month variation in numbers during the pandemic compares with what was happening before the pandemic.

Other reports on Indigenous health checks normally also have a strong focus on rates of health checks – the proportion of Indigenous Australians who received one within certain periods (see Indigenous health checks and follow-ups). Rates make it possible to compare the use of health checks in regions with different population sizes and in different years in regions with changing population sizes. Because of the focus on patterns of monthly variation within regions, a decision was made to use numbers of health checks rather than rates in this report. This makes the presentation of month-to-month variation much more straightforward and robust as there is no requirement to produce monthly population estimates, but also means that more than one health check delivered to the same person is included in the same year in some cases, because people are able to receive health checks 9 months apart.

The number of people who identify as Indigenous Australians has been growing, as reflected by the ABS’ population estimates from Census years. Preliminary estimates from the 2021 Census and Post Enumeration Survey showed a 23% increase in the Indigenous Australian population since 2016, rising from 798,400 people to 984,000 (ABS 2021b, ABS 2016). This is far higher than the 10% increase that was projected, based on natural growth assumptions (ABS 2019).

The changing population size makes comparisons of health check numbers across years challenging, since the numbers alone are not a perfect reflection of how rates of health checks may have changed between years. For example, in areas where the Indigenous population has grown over 2 or more years, a constant number of health checks would correspond to a decrease in service use, in terms of health checks per 100 population.

Greater Capital City Statistical Areas:

Greater Capital City Statistical Areas (GCCSA) are geographical areas from the Australian Statistical Geography Standard (ASGS), made up of Statistical Areas Level 4 (SA4). The GCCSAs are designed such that a geographical area is assigned for each of the 8 state and territory capital cities, in a way that includes people who regularly socialise, shop, or work in the city, even if they live in the areas surrounding the city. The remainder of each state or territory is assigned its own geographical area.

GCCSA are named after the capital cities and states they correspond to, generally following a structure of Greater Capital City and Rest of State or Territory. Exceptions to these are the Australian Capital Territory, all of which is included as a single area in the GCCSA classification, and Other Territories, which cover Jervis Bay, Christmas Island, Cocos (Keeling) Island and Norfolk Island as a separate entity (ABS 2021a).

Suppression:

The health check numbers from Other Territories are incorporated into the numbers for New South Wales (for analysis based on States and Territories), or Rest of New South Wales (for analysis based on GCCSA), to avoid small cell problems. Additionally, suppression was applied for cases with fewer than 6 health checks, fewer than 6 patients, fewer than 6 providers, and where 85% or more of the health checks were delivered by a single provider or 90% or more of the health checks were delivered by two providers. Consequential suppressions have also been applied.

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