Image of medicare card
(Image: AAP)

Many are crediting Labor’s Mediscare campaign with the shock swing against the Coalition, but availability of Medicare services has always been a concern in rural and remote Australia. While Labor spooked voters into believing the Coalition would privatise Medicare and increase the costs of seeing a GP, residents of country Australia are already missing out on $2 million in health funding.

The average yearly Medicare spend per person living in the city is $910, compared to $536 for those living in rural and remote areas.

Medicare spending in remote Australia

National Rural Health Alliance CEO Kim Webber told Crikey we should be spending more Medicare money in rural and remote areas, considering these Australians were “sicker” and more susceptible to illness (more people have a chronic illness in country Australia).

“A lot of this election has been about protecting Medicare, but not a lot about making it work for people [in rural areas],” Webber said.

Webber also bemoans the lack of health professionals in country Australia, which means people are unable to take advantage of Medicare. There is Telehealth, but these consults cannot be billed to Medicare.

“The Medicare system hasn’t been built with flexibility in mind.”

When rural Australians can’t get to a doctor, this means they can’t get primary care, prescriptions and access to pharmaceuticals. “All this underspending, then we have overspending in hospital care,” said Webber.

[Is it time to rethink the possibilities for rural health?]

If there is a GP in a community, there are long waiting lists as the sole practitioner has to service a whole region. It’s very common for patients to drive two to three hours to see a doctor. Some people have to drive for six hours.

People who live in country Australia, one-third of the country’s population, die two and a half years earlier than urban Australians. They are more prone to diabetes, cardiovascular and lung diseases. “The big killers,” Webber said.

“It’s difficult particularly in remote Australia to get good fresh fruit and vegetables, you don’t have a gym down the road or exercise programs that are being delivered in the community.”

Very few rural and remote communities have smoking interventions, as programs tend to get rolled out from the city and don’t reach the people who need them. There is a higher proportion of country Australians who smoke resulting in 40% more deaths from lung cancer than urban Australians.

As part of Labor’s campaign, it released policies in relation to building healthy communities. Labor wants to inject investment and support into 50 communities to “embed healthy attitudes and behaviours”.

Nowhere does it state that rural and remote communities would be a significant number of the 50 selected.

The last significant investment in rural health specifically was 16 years ago. In 2000, then-health minister Michael Wooldridge announced half a billion dollars for country Australia, stating it was the result of people like One Nation’s Pauline Hanson advocating for funding.

Webber said, since then, only “a million here or there” is dedicated to rural health.

“Sixteen years, it’s too long to ignore the third of the population.”

Solving the health crisis

Two weeks ago, the Royal Flying Doctor Service submitted a proposal for consideration by all parties stating whoever forms government should conduct a significant inquiry into the differences in health outcomes between the city and bush, and that whoever is elected should be committed to solutions.

Royal Flying Doctor Service CEO Martin Laverty told Crikey the group spoke up as disparity wasn’t a focus in this election campaign. As a result, Minister for Rural Health Fiona Nash announced last week the Coalition would appoint a commissioner for rural health if re-elected.

“It is our hope an inquiry with recommendations will be made,” Laverty said.

In recent years, the Royal Flying Doctors Service (RFDS) has also been providing dentistry to those who don’t have the financial means to access private dentists.

“Rural children have twice the volume of decay [than urban Australians],” Laverty said.

“It’s never going to be economically sound to incentivise a dentist practice to be set up in small towns where the population doesn’t exist. Therefore, we’ve already got a transport platform, we’ve got 66 aircraft that cover every inch of country Australia. We can move dentists around,” Laverty said.

Nash responded with a commitment of $11 million towards continuing and expanding the RFDS dental services. This was then matched by the opposition.

The dental services the RFDS have delivered to date have only been enabled by philanthropy.

[On the importance of place (and produce) for rural health]

“Both government and opposition have [also] agreed to funding certainty to RFDS medical services until 30 June 2020.”

Labor spokesperson for rural and regional health Stephen Jones told Crikey the biggest threat to rural healthwas the Medicare rebate freeze. However, it was Labor that introduced the freeze in 2013. Jones said it is threatening the viability of the existing doctors in remote Australia.

Mental health and climate change

Considering the rate of suicide in rural and regional Australia is twice that of the capital cities, Labor has also committed to 12 regional mental health initiatives as part of a $70 million investment in mental health. Jones also said Labor would develop workforce programs to encourage allied health professionals and doctors into rural and regional Australia.

When directed towards the $2 billion deficit in rural health spending, Jones agreed “the deficit exists”.

“Certainly the way you don’t decrease that is by increasing the cost of seeing a doctor. This means less people will do it,” Jones said.

Health effects of climate change aren’t often discussed, though lung diseases (already at higher rates in country Australia) will increase with warmer temperatures and more airborne pollutants.

Further drought conditions, a product of climate change, are increasing mental health issues in country Australia. According to the National Rural Health Alliance, “17% of farmers who were in drought in 2008 had mental health issues, compared with 8% of those who had not been in drought in the previous three years”.

Not only drought, but other extreme weather events such as flooding can also reduce access to clean water and availability of food, “placing people at an increased risk of malnutrition”.

Webber said this is an important aspect for the next government to consider.

“The impact of climate change on mental health, productivity and viability of our remote areas, it’s important.

“The government isn’t thinking about it in this context.”

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Peter Fray
Peter Fray
Editor-in-chief of Crikey
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