National Rural Health Alliance Survey Responses to the Working better for Medicare Review

01 March 2024

1. Main Issue

In your view/experience, what are the main issues regarding access to primary care, GPs and/or medical specialists, and their distribution across Australia?

Rural, remote, and regional (rural) Australians and communities make up 30% of the Australian population and experience poorer health than their urban counterparts. The maldistribution of the health workforce contributes significantly to this situation due to reduced access to health services. Moreover, rural Australians have a higher prevalence of health risk factors and rate more poorly against the social determinants of health, despite their significant economic contribution to Australia’s wealth. The burden of disease in remote areas is 1.4 times greater than in major cities; when compared to the rate in major cities, potentially avoidable deaths in very remote Australia are 2.5 times higher in males and 2.8 times higher in females; and life expectancy (years) is generally lower for people living in remote areas and it varies between geographic areas by 14.1 years (males) and 12.4 years (females). Sixty percent of Aboriginal and Torres Strait Islander people live in rural Australia. They have lower life expectancy and a higher burden of disease than non-Indigenous Australians.

Yet the distribution of the health workforce and training for the future workforce is skewed towards metropolitan locations. This is combined with the fact that the costs of service delivery in rural Australia are higher and the tyranny of distance large. Patient through-put in small primary health care businesses is reduced, due to more complex cases, smaller teams, and 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. While Medicare was developed as a public health subsidy to patients rather than covering the whole cost of service, consumers are being advised they should be bulk billed providing further pressure on rural health practices. Thus, it is difficult to run a sustainable small primary health care or multidisciplinary business in rural locations...

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