Trust the evidence on rural health inequities

New data confirms what every primary care doctor knows: primary care keeps people alive and out of hospital.

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The National Rural Health Alliance has called for urgent investment following the release of data that links reduced access to primary care to high rates of likely preventable deaths in rural areas.

Yesterday, the Australian Institute of Health and Welfare released data that suggested that deaths and hospitalisations that were likely avoidable were two to three times higher in rural and remote areas than in major cities.

This data does not come as a surprise at all, co-chair of the RACGP’s poverty and health specific interest group Dr Tim Senior told The Medical Republic.

Dr Senior, a TMR editorial board member, said it was time to trust in the evidence.

“You don’t get good quality primary care on the cheap,” he said. “It needs to be accessible to people. And most importantly it needs to be accessible to people who can’t afford co-payments, because those are the people with worse health already.

“In Australia a large component of that is in rural and remote areas, which we see in this report.”

Dr Senior said general practice services needed to remain person-centered, community-based, coordinated and multidisciplinary.

Speaking on the Health Care Homes trial, which ran from 2017 to 2022 and aimed to provide funding to centres that provided primary-like care for complex conditions, Dr Senior said initiatives such as these could “only work if they’re adequately funded”.

“I think we worked out that I could afford to give my most complex patients a cup of tea or two, and then that was all the funding that we had available to do it and it’s clearly inadequate.”

Dr Senior added that funding for primary care may in fact be getting worse, given the inability of Medicare rebates to keep up with rising costs of providing care, forcing patients to carry the cost.

“I think it’s $4 billion out of primary care with the Medicare rebate freeze.

“The threat of the payroll tax cost pressures on practices makes them less likely to be affordable for the people who need it.

“And then the solution to that is the urgent care centres – which are fine, but that’s not the comprehensive patient-centred primary care that actually keep people well and keep them out of hospital.”

Dr Senior said it was a worrying sign that the lessons from research into the importance of primary care to the health system were not being heeded.

According to Dr Senior, most funding is circumventing primary care, including that going to the heavily subsidised urgent care centes – “that’s money that could be used to actually fund proper comprehensive person-centred primary care, rather than just acute primary care,” he said.

The new data from the AIHW also showed lower levels of health workforce and higher burden of disease and preventable deaths in rural and remote areas.

The burden has risen to 244 disability-adjusted life years per 1000 people in remote and very remote areas, and 200 and 204 respectively for inner and outer regional areas.

As a result, the National Rural Health Alliance chief executive Susi Tegen called for “increased investment in rural healthcare, given the appalling health spending deficit in rural Australia which has compounded the health problems faced by our rural communities”.

“We know the biggest deficits are in accessing primary healthcare as well as other MBS expenditure and private hospitals from a research report the Alliance released in June 2023, ‘Evidence base for additional investment in rural health in Australia’ compiled by Nous Group.

“The deficit in accessing primary health care then leads to increased hospital expenditure.”

This rural health deficit was put at $6.55 billion annually by the Nous report.

“That equates to approximately $850 per person per annum in the context of a population of more than seven million people living in rural Australia,” said Ms Tegen.

“There is clear evidence that per-person spending on healthcare is not equitable, and that this inequity is contributing to poorer health outcomes experienced in rural areas.”

The alliance promised to continue to work with all levels of government and communities to deliver sustainable solutions to reduce the inequities in access to primary care.

“However, these require innovative thinking, equity and funding flexibility, because a city plan often does not fit nor work in rural Australia,” said Ms Tegen.

“Current funding models and service delivery arrangements create significant barriers to workforce recruitment and retention, further exacerbating the funding shortfall. Providing rural people equitable services is crucial. The need for greater and more strategic investment in the health of rural Australians is urgently felt and must be addressed. We have a social and economic contract to do so.”