Innovative and flexible funding arrangements for primary healthcare are urgently needed to address the inequities faced by Australians living in rural and remote communities, according to Susi Tegen, Chief Executive of the National Rural Health Alliance.
Susi Tegen writes:
The latest data released by the Australian Institute of Health and Welfare (AIHW) certainly paints a dire picture of what continues to occur in rural and remote communities in relation to health access and health outcomes.
The updated Rural and Remote data analysis by AIHW on 11 September 2023, as part of its rolling program of revising information, shows that people living in rural and remote Australia have higher mortality rates and potentially avoidable deaths than those living in major cities.
This has been a recurring fact in much of the research undertaken on rural health over the years and a priority and key advocacy point for the National Rural Health Alliance (the Alliance).
AIHW’s updated data points to coronary heart disease as the leading cause of death across all remote areas. This is similar to our findings published in Rural Health in Australia Snapshot 2021 and our fact sheet about cardiovascular disease in rural Australia.
AIHW data further shows age standardised rates for coronary heart disease were between 1.1 and 1.7 times higher outside of major cities than for Australia overall between 2017 and 2021.
Potentially avoidable deaths
Land transport accidents was another one of the leading causes of death in remote and very remote areas. The rate of dying due to land transport accidents was nearly three times as high for remote areas and nearly four times as high for very remote areas compared with Australia overall. There has been minimal improvement in this statistic over the last 10 years.
AIHW further reports that the rate of potentially avoidable deaths under the age of 75 from conditions that are potentially preventable through primary or hospital care, such as cancer screening and transport accidents, increased as remoteness increased.
In 2021, 16 percent of all deaths in Australia were potentially avoidable. After adjusting for age and comparing with major cities, the rates of potentially avoidable deaths were 2.3 times higher in remote and very remote areas.
This is similar to the Alliance findings in 2021 published in Rural Health in Australia Snapshot, that potentially avoidable deaths in very remote Australia are 2.3 times higher in males and 3.0 times higher in females when compared to the rate in major cities.
The rate of potentially preventable hospitalisations increases with remoteness and is highest in very remote and remote areas. This means when conditions where hospitalisations could have potentially been prevented through the provision of appropriate individualised, preventive health interventions and early disease management, usually delivered in primary healthcare and community-based settings.
The Alliance maintains that innovative and flexible funding for preventive primary healthcare in rural settings would increase chances to save lives.
AIHW data further shows that in 2021-22, the number of hospitalisations per 1000 people was similar for major cities and regional areas. People living in very remote areas were hospitalised at almost twice the rate as people living in major cities and those in remote areas at 1.3 times the rate with no improvement since 2013-14.
All these data and findings support what was identified in the Alliance report undertaken by Nous Group titled Evidence base for additional investment in rural health in Australia.
Social determinants
The Nous Group found a triple disadvantage for rural Australia which were social determinants of health, higher cost of access and delivery, lack of scale, distance as well as poor service availability. In addition, people living in rural, regional, and remote Australia are impacted by floods, fires, and drought.
The Nous analysis shows an underspend of approximately $850 per person living rurally compared to those in metropolitan cities. At a macro level, this equates to a massive $6.55 billion rural spending deficit.
The report demonstrates the need for greater and more strategic investment in the health of rural Australians.
There is unmistakable evidence that per-person spending on healthcare is not equitable, and that this inequity is contributing to poorer health outcomes experienced in rural areas.
The biggest deficits are in accessing primary healthcare and MBS expenditure and private hospitals. The deficit in accessing primary healthcare then leads to increased hospital expenditure.
This is a sad reflection in Australia, a wealthy country, with people missing out on essential primary healthcare, ending up sicker and staying in hospital for longer.
The current pattern of health service use indicates a missed chance for early intervention, preventative healthcare, and cost-effective general practice and allied health services in the community. As a result, there is a higher burden of severe disease, leading to increased usage of emergency and hospital services, and increased cost to the healthcare system.
Tailored funding
A one-size-fits-all approach to funding arrangements is not effective in addressing the complex challenges faced by non-urban communities.
Funding models that are tailored to the needs and challenges across the breadth of rural, remote, and regional Australia areas are required, as they have more in common with each other, than they do with urban delivery of care.
This includes addressing the market failure and thin markets that are inherent in these regions, supporting the recruitment and retention of the health workforce that work along the patient or consumer journey, and ensuring ongoing access to essential healthcare services.
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