Budget delivers big for small town Australia

If you only had eyes for the dollar bills in this year’s Federal Budget, you may have missed something big when it came to rural health. While there was significant funding invested in rural health care, the biggest outcome for rural communities was more nuanced. And done right, it should continue to deliver for rural Australia well into the future.

From next January, and for the first time in Medicare history, the Rural Bulk Billing Incentive (RBBI) will progressively increase from the current rate of 150 per cent of the incentive in metropolitan areas (as classified under the Modified Monash Model, or MMM) to:

• 160 per cent in MMM 3–4 locations
• 170 per cent in MMM 5 locations
• 180 per cent in MMM 6 locations
• 190 per cent in MMM 7 locations (an additional $12.35 per consultation above the service rebate).

The geographic eligibility for claiming bulk-billing incentives for after-hours services will also be updated to use MMM classifications.

There will also be:

• an expansion of the now-called John Flynn Prevocational Doctor Training Program to provide more rurally based training placements for junior doctors (with the additional placements to be in MMM 3–7 locations and, while more places are still required, it’s a good start)
• an additional $2.2 million to expand collaborative primary care models to address shortages of health professionals in MMM 3‑7 communities.

While all these measures are welcome in their own right, it’s the long-term, big picture benefit for rural health that is the most exciting bit! It signals a redefinition by the Government of what it means to be a doctor or other health professional in a ‘real rural’ setting, as opposed to a ‘large regional city’ setting.

For many years, RDAA and other organisations have argued that rural health policy measures implemented by consecutive governments have not recognised the different challenges facing rural and remote doctors compared with those practising in the large regional cities.

In some cases, workforce measures aimed at encouraging and supporting doctors to move to small rural communities have also been available to those living and working in big regional cities like Cairns – and, for some measures, even Hobart.

We have always said that doctors and other health professionals in large regional cities may also need additional support measures – but these should be different to the measures intended to encourage more doctors to move to smaller rural and remote communities.

While the Modified Monash Model was implemented to better differentiate between large regional cities and smaller rural and remote communities, consecutive governments have largely continued to treat regional, rural and remote locations the same, particularly when it comes to incentive programs aimed at enticing more doctors to the bush.

This has made it much more difficult to entice doctors to smaller rural and remote communities.

Using the Modified Monash Model to implement more targeted approaches to measures like the Rural Bulk Billing Incentive signals a significant move away from the ‘one-size-fits-all’ approach to rural health policy.

This reform has been a central plank of RDAA’s Rural Medical Workforce Plan and we welcome this strong indication from the Government that more rural health policy decisions in the future will be based on the better differentiation of regional, rural and remote locations.

But, like anyone who has worked in rural health policy for a long-time, we are realists! We need to see more proof of the pudding going forward and we will be continuing to work closely with the Government to ensure future rural health policies better reflect the differentiation in Modified Monash Model classifications.

This new approach from the Government is far too important to simply be relegated to the scrap heap as a ‘one Budget wonder’ – it must become the ‘go to’ approach that drives the delivery of a strong future for rural health care.