Almost four decades have passed since the advent of Medicare revolutionised health care and much has changed in both the health conditions that people manage and the ways that care can be delivered. However, Australian health policies have not kept pace with change. Now the COVID-19 pandemic has exposed and exacerbated inequities in Australia’s health.
For rural Australians, the health advantages of living away from Australia’s major cities can be outweighed by higher levels of social disadvantage, inferior access to health services, and higher occupational injury and health behaviour risks. These factors are associated with poor health and shorter life expectancy for many rural people. The gap in health equity will only widen if we do not turn our attention to addressing health care that has been delayed or deferred over the course of the pandemic.
The Australian healthcare system needs recalibration to address this gap and preserve universal access to health care into the future. Support and reform are required to create conditions that can enable the innovation needed to address many longstanding issues that create unnecessary barriers for rural and remote communities. This must promote the development of regionally appropriate models of care, to enrich local provision of health care and reduce the equity gap.
Several practical reforms are needed to underpin a suitable environment for reform: better data, a sustainable workforce and longer-term funding approaches for rural and remote reform. A short list, but they are reforms that require a whole-of-system vision and commitment.
Health data that reflects care outcomes can inform decision-making within care relationships between patients and providers, as well as system improvements at both a regional and national level. Prioritising the development of the National Health Information Strategy – and establishing data standards, ICT architecture and reporting capabilities – is a critical pillar for measuring what matters to communities and translating that data into meaningful reform.
The health workforce has become further stretched throughout the pandemic and acutely so in rural areas. To address this, there must be a comprehensive health workforce reform strategy. To promote sustainable improvements in care, this must go beyond the adequacy and distribution of the workforce; there must also be support for local clinicians to evaluate care pathways and identify improvements, as well as team-based models of care established to address regional needs, with each member of the workforce practising to the top of their scope.
Rural and remote healthcare reform has long suffered from short-term approaches to funding, with trials and pilot projects ineffective at providing the stability needed for sustainable service innovation. To protect equity and ensure viable long-term reform, longer-term approaches are required that provide accountability for achieving defined goals and in a continuous co-design process that can give rise to more innovative and iterative models of care.
Collectively, these reforms provide a foundation for rural and remote health services to harness data, local expertise and funding resources in a coordinated fashion, to accelerate regional innovation and reform. To enhance rural health care, and in the aftermath of the pandemic, government needs to take seriously the structural reforms that can cultivate a more equitable, locally relevant and outcomes-focused future for the healthcare sector.