Editorial: Bold reform plan for rural health goes to the heart of local communities

  • Building with Community Hub and Reception signage

The priority of the National Rural Health Alliance (the Alliance) in this election year is advocating for holistic and strategic transformation of the rural health sector.

It is inexcusable that the number of health providers (per capita) in rural areas is half the number available in major cities. A threadbare workforce and fewer services mean rural people utilise Medicare and the Pharmaceutical Benefits Scheme at a much lower rate. This creates a shortfall in health dollars spent by rural people, which the Alliance estimates to be around $4 billion.

The rural health crisis has dragged on for decades with fragmented approaches such as a variety of workforce incentives and funding of small trials and pilot initiatives. The lack of a national strategic framework has led to this patchwork of responses without any evaluation of their effectiveness to date.

This piecemeal approach has not provided sufficient scale or impact to solve the fundamental systemic issues of workforce shortages, lack of access to services and the affordability of rural health care.

To coalesce the well-intended efforts of government, and coordinate across jurisdictions and health disciplines, we must have a new National Rural Health Strategy and accompanying implementation plan with clear measures to evaluate its effectiveness. A nationally coordinated strategy will enable government to make a decisive commitment to rural health with aligned policies, proper investment and robust evaluation.

Under a national strategy the Alliance is proposing a different model of rural health care called Rural Area Community Controlled Health Organisations (RACCHOs). Complementing the Aboriginal Community Controlled Health Organisations (ACCHOs), the structure and governance of RACCHOs are flexible and locally designed to accommodate community circumstances.

In this issue of Partyline we hear from Associate Professor in General Practice and Rural Medicine Dr Sophia Couzos who worked with the National Aboriginal Community Controlled Health Organisation to better the health of Aboriginal and Torres Strait Islander peoples. Dr Couzos says, ‘The Aboriginal Community Controlled Health Service model of care was effectively a game-changer as it flipped the health system power structures towards being more patient-centred, well before the term had even been invented.’

This type of wholesale change is needed to address the challenges unique to the rural health system, to enable the seven million people in rural, regional and remote Australia access to the health care they need.

What are RACCHOs?

RACCHOs are underpinned by federal government block funding in smaller rural communities to ensure that health services remain sustainable and affordable. Our current Medicare rebate system rewards high-volume patient throughput which does not work for smaller rural GP practices. 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 out of reach for many rural people.

RACCHOs will differ in each location, with strong community input to ensure service planning and delivery is based entirely on local needs. They can provide primary care, in-reach services for residential aged-care facilities, support for NDIS recipients, 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 multidisciplinary 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 organisation Members, is confident RACCHOs will go a long way towards achieving rural health equity by providing affordable, comprehensive, multidisciplinary primary healthcare services.

The Alliance is confidently proposing the immediate funding and rollout of 30 RACCHOs across the country.

The complexity of our rural health system is evident in our March Partyline issue, which profiles more than 50 individuals and organisations working to improve the health and wellbeing of those living in rural, regional and remote Australia. My thanks to all contributors and advertisers and especially to our Friends of the Alliance for their continued support.

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