The National Health Reform Agreement mid-term review provides a ‘glimmer of hope’ for rural patients and practitioners alike.
The government has heeded the voices of rural Australians, says National Rural Health Alliance, as it praises the recently released final report of the mid-term review of the National Health Reform Agreement.
“Rural Australia, which makes up 30% of the population, is currently significantly under serviced, by $6.55 billion per annum,” NRHA chief executive Susi Tegen told The Medical Republic.
“Rural people are much more unhealthy than people in urban areas, purely because of the tyranny of distance and because of access to health and medical services,” she said.
“So when the [federal] government is making a commitment to significant change and taking responsibility to work in partnership with state governments to improve the health outcomes for Australians, it’s really exciting for [the NRHA].”
The government’s NHRA report, which was circulated to health ministers in October but only publicly released last week,focuses on public hospital funding and doesn’t strictly speak of general practice.
But unsurprisingly the flow-on effects are expected to be far reaching.
“Over the last 20 to 25 years, primary care has really been left behind,” Ms Tegen said, and where the “market fails” in primary care is when urban and rural practice is painted with the same brush.
Ms Tegen hoped that through collaboration, state and federal governments can enable locally-focused primary care solutions that start with the needs of communities and build on infrastructure already in place.
The report highlighted the alliance’s recommended primary care model – the Primary care Rural Integrated Multidisciplinary Health Services (PRIM-HS) – as a case study, a “fantastic outcome for rural people,” said Ms Tegen.
The model focuses on overcoming one of the major barriers to providing good rural primary care: the workforce shortage.
“PRIM-HS releases practitioners from the major commitment of establishing their own practices with the attendant responsibilities of operating a financially viable, standalone business, such as managing staff, administration and compliance in what are often thin rural markets,” said the alliance.
“This employment model makes it easier for health professionals to take up a rural position, knowing they can focus on their professional practise without the stress of establishing, purchasing or managing a practice.”
Ms Tegen told TMR that the model was developed with communities and stakeholders to create a multidisciplinary, flexible model that can be transposed to different regional/remote areas, depending on their needs.
The government needs to look to hybrid models that may include locum and local workforces, and flexible funding options to fill the gaps left by Medicare, which was never meant to cover all service costs, she added.
“At the moment, rural communities in particular are being asked to jump through hoops,” she said.
“They’re exhausted and the red tape is onerous.”
The system, however it may be funded, needs to provide a “smooth” patient journey from primary to tertiary healthcare while also providing workable conditions for doctors, added Ms Tegen.
If we continue to allow some communities to get sicker, we will be unable to be “economically viable and vibrant” and will “not meeting our social contract to ensure that all Australians have access to equitable health care”, she added.
Beyond a duty of care, with two-thirds of Australia’s export income and half of its tourism income coming from rural populations, it’s shocking that governments aren’t “throwing everything at” addressing the inequity, said Ms Tegen.
“This [report] is timely,” she added.
“It sends glimmers of hope that this government means to make some major changes.
“We’re really pleased that there is an acknowledgement that rural [health] can no longer be serviced the way it currently is.”
In its media release responding to the report, the NRHA hailed the government’s recognition that urban models often don’t work in rural/remote settings.
“The review shows a clear path for health reform for the next 10 years,” said Ms Tegen.
“We’re extremely pleased that our years of advocacy have come to fruition.
“This also sends a clear message to our rural communities that they’ve been heard.
“We look forward to the immediate implementation of these recommendations, to ensure that rural people finally have a path towards health care access equity with urban Australia.”
It remains unclear which recommendations from the report will be implemented, but the Prime Minister praised the report to the National Cabinet last Wednesday.
