It is soul destroying to see and hear, over and over, stories such as, “Appalling, unforgivable: the shame of rural health neglect laid bare” (Liz Hayes, SMH Opinion February 4, 2022). It’s also soul destroying to confront, over and over, the impenetrable political armour of public officials who are supposed to be our rural health champions.
The NSW Inquiry into the state of regional hospitals has highlighted such deep issues for rural health, not just in the acute area. Sadly, the issues extend beyond hospitals, and NSW. The system of providing primary health care services to people living outside major cities is also perishing before our eyes.
A holistic and strategic approach is needed to turn around the rural health crisis. Over the past several decades, fragmented approaches, such as small trials and pilot initiatives, haven’t had sufficient impact to solve the fundamental systemic issues of workforce shortages, lack of access to services and the affordability of rural health care. More political ‘announce-ables’ are being fired off this sitting week to plug gaps and look proactive.
To give the benefit of the doubt, the National Rural Health Alliance says these are hugely well-intended efforts by government, but to coalesce these efforts and to coordinate across the health and medical professional bodies we must have a new National Rural Health Strategy to oversee whole-of-system change rather than reactive, piecemeal approaches.
It is inexcusable that people in rural and remote communities are denied reasonable access to health care and have around half the number of health providers per capita than major cities. If rural health services don’t exist, people cannot access the health care they need. Lack of services means rural people utilise Medicare and the Pharmaceutical Benefits Scheme at a much lower rate, which results in an expenditure shortfall in rural and remote areas. The National Rural Health Alliance estimates there is a ‘spending shortfall’ of $4 billion in rural health annually – that’s $4 billion in taxpayer funding that doesn’t reach country and remote areas.
Under a nationally coordinated strategy, we are proposing a different model of health care called Rural Area Community Controlled Health Organisations (RACCHOs). RACCHOs are a potential game changer for guaranteeing equitable health care for Australia’s seven-million rural and remote community residents, but it requires a strong and decisive commitment from government. There is evidence to show that partnered with government, RACCHOs could offer the primary care necessary to help prevent rural people getting ill, being hospitalised, and dying prematurely at a much greater rate that city dwellers.
Using the pre-budget vehicle, the Alliance is proposing the immediate funding and rollout of 30 RACCHOs across the country.
RACCHOs have four pillars: block funding through additional, dedicated, and ongoing government investment; team-based employment; place-based health care; and strong local governance. Complementing the Aboriginal Community Controlled Health Organisations (ACCHOs), the structure and governance of RACCHOs are flexible to accommodate local community circumstances.
RACCHOs require block funding because the evidence shows that in rural areas, activity-based funding is not sufficient to support sustainable health services. What works in city practices doesn’t translate to small country practices where there is rarely the critical mass of people to support viable private health services. So, our current fee-for-service Medicare rebate system that rewards high volume patient throughput does not work for smaller rural GP practices. It’s just incongruous. The situation is even worse for many private allied health services, as there are very few MBS items that patients can claim, making those services unaffordable for many rural people.
RACCHOs will differ in each community, with strong community input and service planning and delivery based entirely on local needs. They can provide primary care, in-reach services for residential aged care facilities, support for NDIS recipients, support chronic disease management plans and DVA health care services.
RACCHOs address identified workforce barriers, to the point of being able to offer financially and professionally rewarding careers and lifestyles in the bush. Health professionals are employed with guaranteed income as part of a multi-disciplinary team, allowing them to reach their full scope of medical and health-related practice.
The Alliance, backed by the expertise of its 42 health and consumer member organisations, is confident RACCHOs will succeed in providing rural patients with access to affordable, comprehensive, multidisciplinary primary healthcare services.
The RACCHO model is gaining significant traction across the health sector and with policymakers, including being embedded in the Draft Primary Health Care 10 Year Plan. The policy reform is substantiated, costed, well supported and ready for action.
Nicole O’Reilly
Chairperson
National Rural Health Alliance