Rural health leaders have discussed a proposal to restrict Medicare telehealth rebates by geography.
A proposal to “ring fence” MBS telehealth rebates to local government areas with demonstrated need is a novel suggestion for improving rural health – but it may just work.
The idea came from VisionFlex managing director Joshua Mundey, speaking at a Health Services Daily webinar this week. Health Services Daily is The Medical Republic’s sister publication.
Mr Mundey suggested that services should be delivered through an approved provider.
“I did promise to ruffle some feathers,” he said.
It was one of many suggestions at the webinar, which featured former NSW Minister for Regional Health Bronwyn Taylor, Royal Flying Doctors (Southeastern Section) chief medical officer Associate Professor Shannon Nott, and VisionFlex director of clinical innovation, Ben Chiarella, with more than 560 attendees.
While panellists were divided on what reform should look like, they all agreed that there was “no silver bullet” in rural health policy.
“The reality is that there will be different nuances that are specific to each rural or remote town,” Professor Nott said.
“When you’ve been to one rural town, you’ve been to one rural town.”
That didn’t stop the panellists from trying.
While people may trust virtual care, Professor Nott said they desperately need connection, continuity, and practitioners who understand patients’ context – who “get red dust on their boots”.
“I go out and speak to pastoralists out north of Broken Hill up in Cameron’s Corner Country, frustrated when they’re talking about shearing or mustering, and clinicians don’t understand what they’re talking about. It’s just those little elements,” he said.
Due to the lack of GPs in areas further west of Dubbo, Mr Chiarella pointed out an elderly patient with COPD who drives a 250 km round trip every four to six weeks for their GP appointment, on roads that aren’t the safest.
However, while contemporary high-performing health services require hybrid models – face-to-face care supplemented by virtual appointments – Professor Nott cautioned against allowing “an easy slippage where virtual care is centralised”.
An overreliance on digital access, he said, could further widen access gaps for patients who can’t afford digital devices, lack reliable broadband, or feel they can’t access healthcare at home because they fear their privacy could be jeopardised.
But for this to happen, Ms Taylor instead questioned how allied health workers could be encouraged to engage with these rural communities.
“You’ve got to have something for their partners to do. You’ve got to have jobs, you’ve got to have good schools, you’ve got to have communities that people want to be part of.”
“If we train people locally, they’ll want to stay locally,” she said.
Both Ms Taylor and Professor Nott agreed country university centres and end-to-end rural medical schools are not solely tertiary education models but regional development investment models.
However, he said virtual care can benefit rural and remote areas through initiatives such as the Virtual Clinical Pharmacy Service, which he co-led.
Professor Nott described a hybrid model designed to reduce medication misadventure risk where no on-site clinical pharmacist was available, drawing on WHO best practice guidance.
“How can anyone manage a patient if they’ve got no idea where in the world they are, what resources are available to them, what the referral networks are, and what the communities’ challenges are?”
However, Ms Taylor pushed back against political attempts to “demonise” virtual care and said she was in Parliament during the NSW parliamentary inquiry into rural health, following reports of preventable deaths in under-resourced rural hospitals.
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She described it as an opportunity “to absolutely knife virtual healthcare” that left “a long road of damage in its wake”.
Mr Mundey floated the “biggest lofty goal of the day” of extending health budget planning cycles beyond the four-year political term to six or eight years, to insulate rural health policy from electoral cycles and build the bipartisan support necessary for longer-term programs.
Ms Taylor agreed with the notion but was sceptical, given federal funding is primarily tied to three-year terms, regardless of any state-level reform.
It was also the exact aim of a parliamentary inquiry into service coordination in NSW that she had chaired.
“I provided all the evidence… but it went nowhere. It’s a really good example of when politics gets in the way of good policy,” Ms Taylor said.
All three panellists called for a dedicated state-level rural and regional health minister to be reinstated – a portfolio Ms Taylor held before it was axed in 2023.
“When you haven’t got someone around the cabinet table that is constantly thinking about their portfolio and what needs to happen, you lose that traction,” Ms Taylor said.
Mr Chiarella said the sector needed a stronger, unified voice when Medicare and national digital health services are designed.
On scope of practice, Ms Taylor, now a Pharmaceutical Society of Australia board member, said 330 towns in Australia have a pharmacy but no GP, and called for pharmacists, physiotherapists and nurse practitioners to practise at the top of their scope.
She said this would allow, for instance, physiotherapists to initiate pain treatment before a GP consultation, in collaboration with a treating doctor, provided the care standards are maintained.
Mr Chiarella said although the technology and clinical models for collaborative, pharmacy-based care were already in place, the main challenge was the absence of funding mechanisms to integrate them.
Professor Nott cited examples of workforce pressures driving these debates, naming towns including Warren, Gilgandra and Candelo in western NSW, where RFDs had become the “last resort” after local general practices were dismantled.
He said equity gaps, once labelled a problem only in the most remote areas, were “trending concerningly further and further east, moving closer to major cities”.
Mr Chiarella described rural and remote healthcare as “unfinished business” and called for additional funding levers to be directed to communities that need them most.
The best models, he said, build on what a rural community already has, using a hub-and-spoke approach such as the Virtual Rural Generalist Service.
