By Julie Robotham and Joel Gibson, The Sydney Morning Herald

A SEPARATE funding agency that would use financial levers to improve the quality of health-care offered to Aborigines has been cautiously welcomed.

But leaders in Aboriginal health said yesterday community consultation would be critical to ensuring the proposed national payment system was acceptable to indigenous patients and kept free from the bureaucratic overload that has hobbled previous initiatives.

The system is modelled on the Repatriation Commission's funding mechanism for veterans of the armed forces.

An Aboriginal and Torres Strait Islander Health Authority would give people who chose to register with it access to bulk-billed health care from doctors and organisations accredited to provide culturally appropriate medicine to Aborigines. Registration would be voluntary, and those who opted not to join it would still be covered by Medicare.

John Daniels, the medical director of the Aboriginal Medical Service Redfern, said the initiative would require extensive consultation with Aboriginal health organisations.

"The presumption that government agencies are more expert [in indigenous health] than Aboriginal communities needs to be addressed," he said.

Naomi Mayers, the service's chief executive, said the success of an authority would depend upon how it was constituted, who ran it and how they were appointed.

Ngiare Brown, the director of the University of Sydney's Poche Centre for Indigenous Health, said people would have "issues around participation and control" and would need to be convinced that signing up would benefit them.

But the authority might be a sound mechanism to boost funding, Associate Professor Brown said. "I think the conversation needs to be had about how we can better resource Aboriginal health."

She also welcomed a proposal to support a more formal network of Aboriginal Community Controlled Health Services. Smaller groups could act as satellites and receive administrative support from the larger organisations, which cater to indigenous communities in regional and remote areas as well as inner-city areas.

But she said the services were sometimes overwhelmed by disproportionate bureaucratic requirements, which should instead be shifted towards health departments.

"I'm all for accountability but obviously it's frustrating and inefficient if you have staff members tied up in reams of paperwork, writing menial reports for minimal amounts of money," Associate Professor Brown said.

The reform report emphasises that improving the health of indigenous Australians will require additional spending rising to $500 million a year.

Associate Professor Brown said meaningful improvement to Aboriginal health would require "a many-fold increase in health investment. If we continue at the current rate, we'll continue to have these parallel outcomes [when] we want to eliminate the disparities."

FALLING THROUGH THE CRACKS

Indigenous Australians:

• Are born with a life expectancy 17 years shorter than other Australians.

• Are three times as likely to die before the age of 15.

• Are 2½ times as likely to suffer from disease generally, including diabetes (three times as likely) and kidney disease (more than 10 times).

• Receive an average of $4718 a person in health services a year - 17 per cent more than others.

• Suffer almost the same health gap whether they live in urban or remote areas.

• Make up 1.6 per cent of health workers, but 2.5 per cent of the population.

• Are 19 times more likely to be discharged from hospital against medical advice.