The 44,000 Australians blocked from Medicare

The change in federal government and a recent coronial inquest in Victoria have renewed calls to provide Medicare to people in Australian prisons.

There are about 44,000 Australian citizens who are currently entirely locked out from accessing Medicare.

Under a technicality in a law that has been in place for about four decades, people in prison and youth detention cannot access the Medicare Benefits Schedule (MBS) Pharmaceutical Benefits Scheme (PBS), despite widespread and long-running campaigns by advocates, lawyers, experts and health organisations to change this.

Healthcare in prisons is currently the responsibility of state and territory governments, and is often outsourced to private companies.

The new Labor government and Health Minister Mark Butler are being urged to make a slight amendment to the Health Insurances Act to extend Medicare to people who are incarcerated in Australia, in an effort to improve the quality of healthcare in prisons and close the health gap between Indigenous and non-Indigenous Australians.

“This is really up to the Commonwealth government and the new Health Minister,” University of Melbourne Justice Health Unit head Stuart Kinner says.

“We have a government purporting to be committed to closing the gap, but while we have Indigenous people over-represented in prisons and the government is sitting on its hands and refusing to exercise its power to ensure appropriate healthcare for Indigenous people who are incarcerated then that seems a little hypocritical to me.”

The recent coronial inquest into the death of Aboriginal woman Veronica Nelson at the Dame Phyllis Frost prison in Victoria shone a spotlight on the delivery of healthcare in custody and the chasm that exists between this and healthcare delivered in the community.

In its submission to the inquiry on behalf of Nelson’s partner Uncle Percy Lovett, the Victorian Aboriginal Legal Service (VALS) called on the federal government to ensure incarcerated people have access to the PBS and MBS.

“The Victorian government should advocate with the Commonwealth to enable this access, in order to provide equivalence of care to Aboriginal and / or Torres Strait Islander people and other vulnerable people held in prison,” the submission said.

People in prison are meant to have access to “equitable” healthcare, but this is not even close to being the case, particularly for incarcerated First Nations people, VALS CEO Nerita Waight says.

“It is really shameful that Victoria is not living up to this basic human right,” Waight says. “We know that one of the biggest causes of preventable Aboriginal deaths in custody is poor quality access to healthcare in prisons.

“People in Victoria’s prisons do not have access to Medicare or the PBS and prison healthcare has been contracted out to private companies which have faced intense criticism for the poor quality service they deliver.”

Prison healthcare ‘unambiguously insufficient’

The Health Insurance Act includes a clause to prevent “double-dipping”, such as when a service is already paid for by a state government.

This law means that people in prison are excluded from the scheme because state and territory governments are theoretically providing equivalent services.

But this has proved time and time again to not be the reality of the situation.

“The assumption was that the state was picking up the tab for all the necessary healthcare for people in prison and youth detention,” Kinner says. “But what’s happened over time is it’s increasingly clear there is not equivalence of healthcare between prisons and the community.

“There is unambiguously insufficient funding in the system for prison healthcare providers to provide equivalent care. Those that bulk bill for services cannot bulk bill for the same services for the same people while in custody, who are not getting that service from the prison health provider. That’s the problem.”

This position is supported by numerous organisations and experts.

The Royal Australian College of General Practitioners (RACGP) and Australian Medical Association (AMA) have backed extending Medicare to people in prison for several years.

In 2017 the RACGP wrote to the previous Coalition government about the issue, pushing for a specific exemption to grant people in prison access to certain Medicare item numbers.

“Our knowledge that the state / territory health services delivered in prisons are not equivalent to the services provided in communities via general practices,” the RACGP said.

The AMA in 2012 said people in prison should retain Medicare while in prison.

“The loss of Medicare and PBS entitlements while in prison is inconsistent with best practice in throughcare, and serves to exacerbate the cycle of ill-health experienced by prisoners and detainees as they move between prison and the community,” the AMA said.

This has been consistently rejected by the federal government.

The quality of healthcare in prison has a significant impact on the rehabilitation of individuals, Waight says.

“Poor quality healthcare in prisons does not just impact incarcerated people, it impacts the whole community,” she says.

“Poor healthcare in prisons can impact rehabilitation efforts, and can also result in poor physical and mental health for people long-term, including after their release.”

An easy fix

The solution merely requires the federal Health Minister to issue an exemption to the exclusion in the Act. It does not require any legislation to pass Parliament, and exemptions similar to this have been done before.

“Why not do the same for people in prison or youth detention?” Kinner says. “I can’t think of any good reason not to. The only reasons I can think of have to do with politics, not with law or costs or services.”

“Medicare is a funding stream. It’s a pot of money to be accessed under certain services, and this is proposed to make that pot of money available in circumstances where it should be available.”

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