On September 20 last year, the Senate Community Affairs Committee tabled its report investigating state and territory travel assistance schemes for country patients.
The report, Highway to health: better access for rural, regional and remote patients, was a damning indictment of the schemes, portraying them as inefficient, inequitable, inconsistent and inadequate.
Submissions to the inquiry told many distressing stories of the impact on patients including:
- An elderly man from a remote NT community died after being left unattended at an airstrip after returning from treatment in Katherine.
- An Indigenous patient was flown from the bush to Perth for treatment without an escort. He didn’t know what to do once he arrived at the airport, and disappeared for six weeks before being found in a park, with kidney failure and other serious complications requiring long-term hospital treatment and rehabilitation. He ended up a quadriplegic.
- A woman was directed to take a 14-hour bus journey after being hospitalised for a miscarriage, and a specialist’s request for her to travel home by air was rejected.
- A NSW patient was unable to receive assistance to travel 400 kms to Adelaide for treatment but could if she travelled 1200 kms to Sydney.
- A Queensland patient had to make a round trip of 220 kms to have her application form filled out by a GP before taking the 1400 km round trip to Brisbane for treatment.
I could go on, but that gives you some flavour of the problems raised by a range of health and community groups. The schemes’ contribution to poorer cancer survival rates in the country — by deterring people from travelling for treatment — was also repeatedly mentioned.
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When tabling his committee’s report, Liberal Senator Gary Humphries noted that some members had been reluctant to do the inquiry “based on some view that this might not be an issue of great substance”.
“I have to say,” he added, “that by the end of the inquiry we were convinced that this was an issue affecting very substantially all people who live in rural and remote areas of Australia and did need very serious policy attention.”
His observation still holds. While some states and territories have made improvements in recent years, these are generally judged to fall far short of addressing the multitude of problems identified in the Senate report.
If the report’s recommendations had been implemented, this month would have seen the establishment of national standards to promote better systems. The report called for these standards to be developed by a taskforce appointed to implement its recommendations.
Instead of completing its work, however, the taskforce has only recently been appointed, under the auspices of the Australian Health Ministers Advisory Council’s national health policy committee. Its chair hopes to make some recommendations for the development of consistent patient assisted travel schemes within the next six months or so.
And so the wheels of bureaucracy turn, excruciatingly slowly.
Meanwhile, as petrol prices soar, eligible country patients who have to travel for specialist care are being reimbursed at a miserly rate of between 13 and 17 cents per kilometre, depending where they live.
Meanwhile, as I report in the latest Australian Rural Doctor magazine, rural doctors say the inadequacy of the schemes is deterring some patients from having treatment. Meanwhile, there are still stories — so ridiculous in this internet age — of patients travelling hundreds of kilometres to get a doctor’s signature on their snail-mail application form.
Meanwhile, in the NT, the inadequacy of air retrieval services is contributing to worrying delays in patients’ evacuation, with reports of critically ill patients waiting up to 48 hours to be evacuated from remote communities.
Remember this story in coming months when you hear grand statements about how the reformers are going to ‘fix’ the health system. What are the odds, if they can’t manage something so straightforward as ensuring a decent and fair system to support people having to travel long distances for care – that in previous times might have been available locally?
After all, unlike many of the reforms needed in health, there is not opposition from various professional groups or other interests. It’s rare to find an issue where such a diversity of interests wants the same thing.
Remember also that 22 years ago this month, the then Health Minister, Dr Neal Blewett, rose in the House of Representatives to explain why a scheme, established by the Commonwealth in 1978 to assist isolated patients travelling for specialist medical treatment and oral surgery, would be transferred to the states and territories.
Dr Blewett said the federal scheme had been widely criticised, by MPs, consumer advocacy groups, individuals, social worker associations, the Commonwealth Ombudsman and the Administrative Appeals Tribunal.
The main concern, he said, was that the Commonwealth lacked the requisite local knowledge and delivery mechanisms to respond flexibly to the needs of different geographical communities.
“The States and Territories are well placed to develop and administer more flexible and effective measures for those in need,” he concluded.
Since that time, many reports have suggested that Dr Blewett’s optimism was misguided. Last year’s Senate inquiry is only the latest in a long line to reach similar conclusions.
Doesn’t engender much confidence about the future of health reform, does it? Join the discussion of this topic on our health forum, Croakey, here.