The government spends about $1100 less on healthcare for each person living outside of Australia’s major cities.
Despite years of advocacy, the gap between the government spend on urban and non-urban health has increased by almost $2 billion since 2021, with a new report estimating the difference to be about $8.35b per year.
For National Rural Health Alliance CEO Susi Tegen, it’s a damning stat.
“Last time I checked, we were a Western country,” she told The Medical Republic.
“To treat rural people – despite their economic contribution – like they’re mushrooms is outrageous.
“The underspending is becoming bigger and bigger, and the medical and health workforce is more and more challenged, and we continue to do as we’ve always done.
“And then we wonder why those populations are getting sicker and are dying six to 13 years earlier than people in the city.”
The NRHA-commissioned report, which was released on Monday, estimated that the gap breaks down to about $1100 less per rural Australian per year.
An analysis conducted in 2021 put this figure at about $850 less per rural Australian per year.
The new report identified public and private hospital expenditure as the biggest source of the gap, with MBS spend contributing around $240 to the $1100 disparity.
The areas where there were shortages of GPs correlated with delayed access to care and heavier reliance on hospital-based services, according to the report.
“For those communities where the market fails, we’re asking for block or blended funding,” Ms Tegen said.
“… It’s very much based on population health need, and then the [existing practice] can support that community according to what the need is; it might include midwifery, it might include allied health for diabetes, it might include covering GP pay because Medicare bulk billing doesn’t cover it, things like that.
“In addition to that, we’re calling for a National Rural Health Strategy, because we believe by keeping rural health under general health, you don’t see the status of the health and wellbeing of the rural population, but also the clinicians on the ground, because they’re really exhausted and stretched.”
Rural generalist Dr Rod Martin, president of ACRRM, said that while it was “disappointing” to see another increase in the rural health funding gap, the primary issue for governments to focus on should be fixing the rural health outcomes gap.
“The funding is there, and lots of the programs are built,” he told TMR.
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“They’ve now just got to be funded to get people into them and out to rural areas.”
Rural Doctors Association of Australia CEO Peta Rutherford told TMR that the story the report told about workforce was perhaps even more dire than the expenditure component.
“Rural GPs report high workloads and considerable rates of burnout relative to GPs in metropolitan areas,” the report said.
“The burnout experienced by health workers is felt across the workforce, not just by individual practitioners, as the industry grapples with structural problems that exacerbate worker fatigue, including poor infrastructure and housing access in many rural and remote areas.”
Access issues, Ms Rutherford said, are becoming a more significant issue.
“People in MM5 in particular, they’re travelling to access services,” she said.
“Now, sometimes that may be because that aligns with lifestyle, as in they work in a larger centre so therefore it’s easier for them to access their doctor after work and things like that.
“But it certainly paints a picture – and if you then think about the elderly and who lives in those communities, how are they able to access services?
“Access to transport, public transport and things like that, just more than road distance, becomes a genuine access issue.”
The long-time RDAA CEO said that rural doctors didn’t want to see a one-size-fits-all model imposed on the bush, and that previous attempts to address rural health had been piecemeal.
“For primary care, improving health outcomes is about access and continuity and comprehensiveness,” Ms Rutherford said.
“Like, it’s an ‘and, and, and’ so it’s not just continuous, or just access, and it’s not comprehensive.
“All the evidence about good positive health outcomes is where it’s an ‘and, and, and’ in the definition.”
