When we talk about rural health, it’s easy to focus on health inequalities between the roughly 10% of Australians who live in rural and remote areas and those who live in our cities.
Statistics show the further Australians live from the major cities, the less their life expectancy and the poorer their health.
But rural health is not just an issue about equitable access to health care services; it’s an economic issue that impacts on national, community and family budgets and life’s opportunities.
The government isn’t investing enough in rural and remote health because of its failure to recognise the comprehensive impact of health care funding as a driver for local economic development.
The federal government’s development plan for Northern Australia doesn’t appear to mention health and health care services at all.
This is despite international research showing investing a dollar in rural health care can generate more than a ten-fold economic return.
How can investing in rural health boost economies?
The best example of health care centres as anchors for economic growth and investment comes from the US. Here, community health centres run primary health care clinics (patients’ initial point of contact with the health system) in rural and medically under-served areas.
Data collected over their nearly 50-year history show these centres not only provide quality and culturally safe health care and related social services to vulnerable populations, they stimulate the economies of their local communities.
There’s a multiplier effect that extends beyond the employment of health care professionals and ancillary staff and beyond the walls of the clinics; the centres buy goods and services from local businesses and the improved health of the local population means increased employment and household spending.
For every US$1 invested in these health centres, an estimated US$11 is generated in total economic activity.
Could this happen in Australia?
Australia has shown little interest in these sorts of analyses and economic justifications for changes in health policy to better service rural areas.
For example, we have no idea what economic impact, if any, GP Super Clinics have had in their communities. These are meant to bring together GPs, practice nurses, allied health professionals, visiting medical specialists and other health care providers to address the health care needs and priorities of their local communities.
And data is limited for the economic impact of Aboriginal Community Controlled Health Organisations, which are similar to the community health centres in the US. Although we know such organisations are the largest private employer for Aboriginal and Torres Strait Islander people, I have seen no economic data beyond this.
What we do know is on the basis of health care costs alone, spending more money more wisely on rural and remote health could result in some significant savings.
For instance, an Australian study showed investing A$1 in medium-level primary care (2-11 visits per year) for people with diabetes in remote Indigenous communities could save A$12.90 in hospitalisation costs.
How best to care for the health of rural Australians?
If we accept there are economic benefits to investing in rural health care, what should our rural health care system or systems look like?
Work from the now-defunded Centre for Excellence for Accessible and Equitable Primary Health Care Service Provision in Rural and Remote Australia gives us some clues.
Researchers said we should agree on a core set of primary health care services to be available to Australians living in rural and remote areas and the necessary support functions to ensure these are sustainable.
Knowing what services are needed allows communities, health professionals and policy makers to ensure they can be delivered in a way that is “fit for (local) purpose” and there are no gaps. It is clear we need something beyond general practice.
They highlighted necessary services including: emergency care, obstetrics (pregancy and birth-related services), mental health and counselling, dental health, rehabilitation, and services for substance abuse, disability and aged care. And of course, there is a range of necessary support functions. These include on-demand specialist back-up, telehealth and video conferencing, and the ability to promptly evacuate seriously ill patients.
Researchers have also looked at the features of effective and sustainable models of primary health care in rural and remote Australia. Key issues were supportive healthy policy, productive relations between federal and state/territory governments and a receptive community; essential services like good governance, management and leadership; as well as adequate funding, infrastructure and workforce supply.
Who will staff primary health care in the bush?
So, how do we recruit, structure and retain the primary health care team needed to deliver these services? Again, we know quite a lot about health care professionals who are more likely to be attracted to the challenges of rural and remote medicine.
Those who love their work in country areas talk about high levels of professional satisfaction, the challenging variety of the work, close relationships with other health professionals, and the sense of satisfaction from their patients.
But the isolation, the struggle with work-life balance, career advancement, schooling for children, jobs for spouses and difficulty finding locums (for instance to back-fill when they are sick, want to take a holiday or need extra training) are causes of dissatisfaction. Future policies need to address these issues.
Looking to the future
Providing sustainable health care services in the bush is possible. But finding the evaluations and anecdotes about what works is not easy.
For instance, it’s now impossible to know from publicly available documents how much federal money is spend on rural health initiatives, let alone their outcomes.
However, websites like Community Commons, which allow people to share their experiences, data and resources about providing health care to local communities, can help.
Expenditure on rural and remote health is a wise use of government resources because it focuses on what private markets are unable to do. It also delivers on outcomes that can be measured in dollar benefits, as well as the social justice currency of a fair go for all Australians.
Yet, there are also concerns that federal government attention to rural health is waning. So, many hopes are pinned on the proposed Rural Health Commissioner to champion the strategic, consistent, long-term and varied health needs of rural and remote communities.
The author, Lesley Russell, is Adjunct Associate Professor, Menzies Centre for Health Policy, University of Sydney. He is talking about the economics of delivering primary health care in rural and under-served areas at the 14th National Rural Health Conference in Cairns today.