National Strategic Framework for Rural and Remote Health

Health services

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Health services in rural and remote areas are very different to their city counterparts.

Facilities are generally smaller but play a vital role in the provision of community-wide integrated health services that may include mental health services, oral health, community and aged care, and social services.

Rural and remote health services are more dependent on primary health care services, particularly those provided by General Practitioners (GPs). Facilities are generally smaller, provide a broad range of services (including community and aged care), have less infrastructure and locally available specialist services, and provide services to a more dispersed population.

These characteristics usually create some unique challenges for health services delivery. However, they also provide opportunities for innovation. Rural and remote services can benefit from innovative approaches such as multi-disciplinary care, using new technologies in the diagnosis and care of patients, and training and expanding scopes of practice for doctors, nurses and other health care workers. The many and varied services provided through rural and remote facilities enables their communities to host interesting, professionally satisfying and meaningful jobs.

Such innovations have contributed towards improvements in access to health services and the quality of care for many rural and remote Australians. In addition, the integrated nature of rural and remote health services places them in a particularly strong position to pursue, and benefit from, the primary care agenda of the current national reforms.

Yet it is widely recognised that further reforms and improvement are still necessary. Health service planning and delivery have traditionally been developed in the context of metropolitan settings. This has resulted in service models and models of care that are better designed to meet the needs of larger cities and towns than those of rural, regional and remote communities.

Traditional training approaches and funding mechanisms have led to the uneven distribution of health care professionals across the country.

This can be seen in the disparity in the number of health care professionals between metropolitan and the most remote parts of the country. For example, in 2006 very remote areas had (AIHW 2009):

  • 58 generalist medical practitioners per 100 000 population (compared to 196 per 100 000 in capital cities)
  • 589 registered nurses per 100 000 population (compared to 978 per 100 000 in major cities)
  • 64 allied health workers per 100 000 population (compared to 354 per 100 000 in major cities).

Almost a quarter (23%) of people living in outer regional and remote areas felt they waited longer than was acceptable for an appointment with a GP, compared with 16% of those living in major cities.  People living in outer regional and remote areas were also four and a half times as likely as those living in major cities to travel over one hour to see a GP
(ABS 2011).

In addition to needing to travel further to access health services, people living in rural and remote areas generally receive a smaller share of overall health spending (NRHA, 2010).

This is generally related to:

  • fewer available GPs, specialist nurses and health professionals
  • more limited access to specialist services.

With these entrenched inequities and complex challenges, achieving better health services and, consequently, improving health outcomes for rural and remote Australians is not an easy task. It requires significant and long term commitment, with a consistent and cooperative effort across governments, and the health industry, education and community sectors.

Rural and Remote Hospitals

Hospital services are an essential component of a contemporary health care system and are particularly important for people who live in rural and remote settings. Achieving more equitable access to hospital services is a very significant issue for rural communities.

Not only do rural patients require access to local hospital services, but they also require planned and predictable access to the more specialised and tertiary type hospital services that are only provided at some major regional locations and in metropolitan centres.

Equity of access for country people must be measured not only by the ratio of hospital beds and facilities available locally to given populations but also by:

  • the standards of safety and quality of rural and remote hospital services
  • the alignment of services provided with local needs
  • availability and sustainability of an appropriately trained and skilled workforce
  • the existence of planned and effective systems to provide safe and predictable access to hospital services at local, regional and metropolitan centres as required.
  • For most rural and remote communities, equitable access is restricted by:

  • the frequent need to travel great distance to access basic hospital services
  • the difficulties involved in accessing more specialised services in regional and metropolitan centres including travel, accommodation, and financial, family and employment related impacts
  • the limited availability of private hospital and related health care services in many parts of rural Australia and the consequent lack of choice for country people.

With increasing remoteness, the size and type of hospital service also changes.  As seen in Table 2, the number of large, specialised hospitals decreases with distance from major cities, and hospital facilities become smaller and more likely to provide multi-purpose and non-acute services.

Table 2: The diversity of public hospitals, 2008-09

(Source: adapted from AIHW 2010a)

Number of hospitals

Location Service provided
Hospital type Major cities Regional Remote Total Emergency departments(a) Accident emergency services(b) Outpatient clinics(c) Elective surgery(d)
Principal referral

50

23

1

74

74

74

69

74

Specialist women’s and children’s

11

0

0

11

9

11

11

11

Large

23

17

1

41

38

41

36

34

Medium

22

70

0

92

34

90

11

55

Small acute

0

110

40

151

18

148

2

33

Psychiatric

10

9

0

19

0

3

0

0

Rehabilitation

6

2

0

8

0

7

1

1

Mothercraft

8

0

0

8

0

8

0

0

Small non-acute

13

62

11

86

4

83

1

2

Multi-purpose services

0

47

32

79

0

79

0

3

Other

32

78

77

187

6

173

0

1

Total

175

418

162

756

183

717

131

214

(a)  This is the number of hospitals reporting episode-level non-admitted patient emergency department care data to the National Non-admitted Patient Emergency Department Care Database.

(b)  This is the number of hospitals reporting establishment-level accident and emergency occasions of service data to the National Public Hospital Establishments Database.

(c)  This is the number of hospitals reporting outpatient clinic-level non-admitted patient data to the National Outpatient Care Database.

(d)  This is the number of hospitals reporting episode-level data to the Elective Surgery Waiting Times Data Collection.

This creates further complexities for planning, managing and delivering public hospital services in rural and remote locations as they:

  • are generally smaller than metropolitan centres
  • have high fixed costs of operation
  • are less able to achieve the economies of scale experienced in large hospitals
  • are often the default service provider in the absence of private sector options, adequate primary health and aged care services provision
  • consistently struggle to attract and retain a sustainable skilled clinical workforce.