The National Rural Health Alliance (the Alliance) welcomes the opportunity to make a submission to the Effectiveness Review of General Practice Incentives. This submission supplements the contributions made via verbal consultations. The Alliance is the peak body for rural, regional and remote health in Australia.
The Alliance comprises 50 Members , and our vision is for healthy and sustainable rural, remote and regional (hereafter rural) communities across Australia. The Alliance is focused on advancing rural health reform to achieve equitable health outcomes for rural communities - the 7 million people residing outside major cities. Our members include health consumers, healthcare professionals, service providers, health and medical educators, researchers, medical and health students and the Aboriginal and Torres Strait Islander health sector.
To place this review in context, the Alliance wishes to highlight the significant contribution of rural Australia to the nation’s economic prosperity. Rural areas contribute at least 80 per cent of Australia’s exports – valued at almost $500 billion a year, almost 50 per cent of tourism revenue and produce 90 per cent of the food we consume. In juxtaposition to this is the recently reported $6.5 billion annual deficit in health expenditure in rural Australia, equating to almost $850 per person, per year.
Rural people experience poorer social determinants of health, have reduced access to healthcare services and are faced with higher costs to access healthcare. As a result, they experience poorer health outcomes – higher rates of health and behavioural risk factors and higher rates of morbidity and mortality due to illness and disease - resulting in a higher burden of disease and reduced life expectancy. Poor access to primary health care and the associated prevention and early intervention services it encompasses, means rural people are more likely to attend an emergency department or be admitted to hospital, than people living in a city and more likely to die of a potentially preventable cause.
We know that providing health care in rural Australia is challenging. The costs of service delivery are higher, yet patient through-put in small primary health care businesses is generally reduced, due to population dispersal over vast distances. This occurs in the context of populations with lower incomes, on average, and hence a reduced ability to pay for care. Thus, it is difficult to run a sustainable small primary health care business in rural areas.
Input from our members and work with rural communities has told us that funding for rural primary health care needs considerable reform. To make the provision of high quality, culturally safe, efficient and effective, multidisciplinary team-based care in areas where markets are thin or failed – sustainable – needs more than just shortterm “band-aid” solutions. The non-fee-for-service components of Medicare funding for primary health care are currently essential to the financial functioning of rural practices. There is room for improvement in the way these incentive programs are implemented, but tweaking at the edges of these programs will not make headway that is large enough to reverse the inequity in rural access to services and ultimately, poor health outcomes.