Rural Health, the biggest Budget loser

Lindy Swain, a pharmacist academic at the University Department of Rural Health and Chair of the Rural Pharmacy Support Network, outlines the impact of the Federal Budget measures on rural Australians, in particular asking what it means to put GPs at the centre of the health system in areas where there are no GPs. She writes:  

Rural people were dealt multiple blows in Tuesday’s Federal Budget, especially in regard to health and education. In Tony Abbott’s first Federal Budget, the spreading of “the burden” was far from equitable and was showed how little politicians understand of the realities of rural Australia.

In general, rural Australians have poorer health, higher burdens of chronic disease and lower life expectancy than their urban counterparts. This burden of disease increases with remoteness. There are a number reasons for this poor health, including lack of health professionals, lack of services, late presentations at hospital, low levels of employment, low levels of education and low socio economic factors.

So how will the budget cuts and taxes announced last night affect rural people and rural pharmacy?

On the north coast of NSW, where I am lucky enough to live and work, like many rural areas, we have high unemployment, especially for youth. The biggest employers in our region are health, education, government, and agriculture. Most people want to work, but with recent cuts (and that’s before the budget) to funding in health, education and services (such as TAFE, Telstra, Grafton gaol, abattoir) it is getting harder to find jobs, even if you do have transport. There is little to no public transport system and the roads are in a shocking state of repair.

The government states that youth need to “learn or earn”, yet it is almost impossible to get an apprenticeship, TAFE has been cutting courses and university is getting more expensive. Many students have to go away to the city to university, costing their families (on lower incomes than urban families) at least $15,000 a year or alternatively the students live in poverty on youth allowance, whilst accumulating their HECS debts.

Many universities are pumping students through courses without good job prospects (pharmacy is a good example), so many students will still be unemployed after university. Put rising unemployment, together with reduced government support, and evidence tells us we will see a rise in mental health, chronic disease, self-harm and substance abuse, as well, of course as increased homelessness and crime. 

In our regional centre, health services are already stretched to the limit, dealing with acute care patients and chronic care patients often have to book 6 weeks in advance to access GP practices. Outlying areas have even less services and innovative models of care are often established by multi-disciplinary teams to assist with GP shortages.

In rural areas there is no over usage of GPs. No one chooses to be sick. Changes to petrol excise regulations and subsequent increased fuel costs will hurt farmers and rural people who have to travel long distances to access employment, education and health care. International models of health service delivery indicate that introducing co-payments for primary health care will increase the number of patients that end up in hospital.

The cost of 1 day in hospital is equivalent to 1 year of GP services for an average patient. Our hospital is already overloaded. How will it cope with more patients? The government is increasing our long term health expenditure (the state’s, that is) not reducing it.

The Medicare Local in our region (only established in 2012) has filled some of the “areas of need” by establishing GP services for the homeless and those in detention, by organising outreach medical services to communities where there are none and providing free Webster packing and medical devices to Aboriginal patients. These programs are just getting established, now they will be revamped into Primary Health Organisations and no one yet knows what services they will be able to provide.

The government commissioned a “Review of Medicare Locals”, written by a doctor. This report did not once mention any health professionals, other than doctors. The review suggested that GPs once again  needed to be “ reinforced as the cornerstone of integrated primary health care”. 

No one denies that GPs have a very important role to play but what about where we don’t have enough GPs and where we have a sick and ageing underserviced populations? Where has the commitment to multi-disciplinary patient centred care gone?  Who will look after the sick and disadvantaged? Where is our commitment to Aboriginal and Torres Strait Islander Health?

As a result of budget changes, pharmacy will probably have fewer patients, bringing in fewer prescriptions. Not only will there be more barriers to patients accessing Drs, patients will also have less money to pay for their more expensive prescriptions.  Pharmacists are already feeling the squeeze as a result of reduced funding under government price disclosure changes.

However, if our population is sicker and accessing the GP less, is there an extended role for pharmacy? Pharmacists can provide very cost effective health care solutions for the government however we need to be reimbursed for the care we provide. We have a well-trained young pharmacy workforce who currently find jobs.

Pharmacists will become increasingly important in providing primary health care for patients who can no longer afford to see their GP or wait for an appointment. Pharmacists’ roles in prescribing and continued dispensing need to be expanded. Pharmacists need to be involved in mental health referrals, diabetes care and preventative health, such as immunisations. Pharmacist clinicians must be integral to patient chronic disease management, working in primary care settings, such as Aboriginal Health Services and GP clinics.   

As the next Community Pharmacy Agreement is negotiated (commences July 2015) we need to lobby hard to ensure pharmacists are paid for the services they provide. As the pharmacy industry faces deregulation, and dispensing medications become less profitable, pharmacists need to be paid for clinical services, as are other health professionals. 

Rural pharmacy, especially, fills the need of patients in areas where there often are little or no other services. We must make sure it is sustainable for rural pharmacists to continue to offer their patients the care they need.