Those crunching the numbers in their ‘Canberra bubble’ need to check their assumptions with doctors working at the rural coalface, an inquiry into rural Medicare access has heard.
Without equitable funding for rural and regional health, every innovation, initiative and Medicare reform risks becoming “a castle built on sand”, an inquiry into rural healthcare funding has heard.
The inquiry into rural and regional Medicare access and funding, by the Senate Rural and Regional Affairs Committee, also heard that the fee-for-service model of Medicare was “broken” and no longer fit for purpose for rural practices, with experts warning that policy makers need to test their figures in reality.
The inquiry heard from National Rural Health Alliance director of policy and strategy Margaret Deerain this morning.
“Medicare access in rural, regional, and remote Australia needs to be prioritised,” Ms Deerain said in her opening statement.
“Rural Australians receive less healthcare funding, less access to care options, and as a result, on average, they get sicker, they are sicker for longer, and they die younger.”
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Ms Deerain said recent reforms including the scope of practice review, the National Health Reform Agreement and the National Health and Medical Research Strategy all recognised the importance of providing tailored solutions.
“But unless we are prepared to fund rural health equitably, every innovative model, every workforce initiative, and every Medicare reform risks becoming a castle built on sand,” she said.
“Would you accept a health system that expected your own constituents, your family, or your friends to receive less healthcare simply because of where they live, or raise money from their own pockets to access services that is readily available in other parts of the country?
“Rural Australians are not asking for more than metropolitan Australians; they are asking for the same opportunity to access healthcare.”
Ms Deerain said telehealth was “an important part of the landscape” but said not all rural practices had the infrastructure to be able to deliver good telehealth.
Rural Doctors Association of Australia CEO Peta Rutherford told the inquiry that the fee-for-service model of Medicare was “broken and no longer fit for purpose for rural and remote practices”.
“We do warn government that they do need to sit down with practices and people that are at the forefront to really test some of their theories and assumptions, because we worry that sometimes sitting in a Canberra bubble, you can crunch the numbers, but that’s not how it works at the coalface,” she said.
Mrs Rutherford said rural and remote practices had become more and more reliant on the incentives available to them.
But it was much harder for rural doctors to access those incentives, she said.
“A lot of the submissions and reviews have talked about this 60/40 split, where 60% of GP revenue in rural communities is the MBS, and the 40% is other grants or incentives that contributes to the funding.
“For that 60/40 split, rural doctors have to work really hard to access those funds. They have to do after hours. They have to do, often, procedural work. They’re providing residential aged care visits.
“There’s a lot that goes into that, and in rural and remote communities there’s nowhere to hide.
“It’s different in metropolitan, where if … doctors have elected not to do residential aged care, they’re not going to get bailed up at Coles when they go shopping and asked why.
“I can tell you in rural communities you get bailed up at the IGA and asked, ‘why are you no longer seeing my mother or my father?’
“There’s nowhere to hide in rural and remote communities if you want to just focus on the more … financially rewarding aspects of general practice.
“You’ve got to provide the full scope of GP type services.
“And often in these communities, to have a sustainable medical workforce, you are reliant on having doctors, GPs, and rural generalists working across not just the general practice environment, but also the hospital environment.”
Mrs Rutherford said using metropolitan arrangements in rural areas was like “fitting a square peg into a round hole”.
“Rural doctors and remote doctors are probably more inclined to innovation, more open-minded to innovation, and are willing to try things. They will sign up. They’re very much community minded.”
