Already fragile, rural health set to suffer more under the budget

A lack of local professionals means rural health is already under pressure and the budget will only make things worse. Len Matthews/Flickr, CC BY-NC-SA

People living in remote and rural Australia already have a shorter life expectancies and higher rates of premature deaths. Last week’s federal budget will not only make that worse, it will introduce even more problems.

Let me explain with an example of what the budget means for one region. I live in rural New South Wales and lead a university department located in a large rural town with a Base Hospital.

There are 120 general practitioners who work in our rural valley and offer after-hours services. These doctors work hard to keep low-income people in their practices; despite advertising fees above the bulk-billing rate, 85% only charge many clients the Medicare rebated fee.

The viability of continuing to subsidise this clientele was already worrying these doctors. Many of them have clinics that employ practice nurses and other general practitioners, and their income is insufficient to continue to do this as well as subsidise poorer patients.

The introduction of the co-payment for visiting doctors will increase the number of local people who don’t seek care from a GP. This will damage their health and the viability of these rural medical centres.

Bad to worse

For the past 12 months, the Medicare Local in our area had provided services for rurally located vulnerable people without a doctor. Despite this effort 20% of the children admitted to the local hospital do not have access to family medical services.

These children – and their parents – do not have the benefit of a GP to implement prevention, early intervention and low acuity care. Nor do they receive general practice care after discharge from the local hospital.

People deterred by the GP co-payment to seek primary care will end up in our hospital’s emergency department. It’s likely these people will be considerably more ill by the time they get to hospital.

Our very busy Base Hospital is already underfunded by about $70 million a year. It’s likely to be further overextended as cuts to the health budget are felt – and it faces the prospect of more ambulance callouts and people needing help in its emergency department.

Not untypical

People in rural areas with poor primary health care are more likely than those in cities to end up in hospital. There’s evidence for this in a 2012 National Preventative Health Agency (NPHA) report that examined 21 causes of avoidable hospitalisations. Two of these are often suffered by children - vaccine-preventable disease and asthma.

Not only does the countryside suffer from a dearth of GPs, community nurses, pharmacists, dentists and allied health practitioners are also rare. And parents and others are stuck in a vicious cycle, because the lack of post-hospital care leads to another hospital admission and so on.

As shocking and distressing as this is, it’s not unusual in rural parts of this country. Our local hospital draws from a typical regional population, which has higher than urban rates of poverty and chronic illness.

Much of our population lives in small communities or towns that cannot sustain a general practitioner, pharmacist or allied health worker. Transport is difficult for many; cars may be shared but petrol is already expensive. And transport is about to become even more costly because of the decision to restore indexation of federal petrol excise.

In a 12-month period North Coast NSW Medicare Local (NCNSWML) provided extensive clinical services where there was a gap and unmet need. NCML

Rural areas have less private health insurance coverage, fewer private practitioners and private hospitals.

Other measures

A number of other budget measures will also affect us disproportionately. The Australian Institute of Health and Welfare - about to become part of the mega National Productivity and Performance Authority, along with five other currently independent bodies - provides us with data that illustrates the inequality of rural and remote health services.

It may lose its autonomy and focus and become subject to political influence.

The National Preventive Health Agency, also to be brought into the health department, is particularly important to rural health. Prevention strategies are sorely needed to address things like the higher rates of smoking in rural areas and these need to be different from what’s done in the city.

Our Medicare Local will be replaced with a possibly larger new primary health organisation. It already covers 35,570 square kilometres, four regional centres, and 30 towns – that’s 495,549 people. To extend this further means its capacity to be responsive and integrate acute and primary care will become impossible.

Families living in rural and remote areas are already struggling to have good health. This budget means they will suffer even more inequitably compared with other Australians.

Correction: This article has been amended to say the AIHW will become part of the National Productivity and Performance Authority. The original incorrectly stated that it would become part of the Department of Health.