NACCHO Aboriginal Rural and Remote Health Research Alert : @RoyalFlyingDoc Health Care Access in the bush Survey


” The RFDS survey of country health consumer priorities was released 100 years to the day since the first patient was treated by a pioneering doctor in Western Australia, leading to the founding of the RFDS which is now recognised as Australia’s most reputable charity.

The survey of 450 country people drawn from every state and territory saw one-third of responses (32.5%) name doctor and medical specialist access as their key priority. Addressing mental health (12.2%) and drug and alcohol problems (4.1%) were second and third priorities

Around seven million Australians who reside in remote and rural areas.

Of these, more than half a million live in either remote, or very remote, areas of Australia. Aboriginal and Torres Strait Islander (Indigenous) Australians are overrepresented in remote and very remote areas—almost half (45%) of all people in very remote areas and 16% in remote areas are Indigenous Australians, compared with a 3% Indigenous representation in the total population

The research paper “Health Care Access, Mental Health, and Preventative Health; Health Priority Survey Findings for People in the Bush



Extract : 4.2.4 Indigenous health issues

Few respondents identified Indigenous health issues as important.

This was disappointing since across all remoteness areas, Indigenous Australians generally experience poorer health than non-Indigenous Australians (Australian Institute of Health and Welfare, 2014) in relation to chronic and communicable diseases, mental health, infant health, and life expectancy (Aboriginal and Torres Strait Islander Social Justice Commissioner, 2005).

However, this result is unsurprising considering the very low proportion of respondents who were Indigenous.

Indigenous Australians are five times as likely as non-Indigenous Australians to die from endocrine, nutritional and metabolic conditions such as diabetes, and three times as likely to die from digestive conditions (Australian Institute of Health and Welfare, 2015b).

Age-adjusted data demonstrated that in 2014–2015 Indigenous Australians were more than twice as likely as non-Indigenous Australians to be hospitalised for any reason (Australian Institute of Health andWelfare, 2016b).

Indigenous Australians are twice as likely as non-Indigenous Australians to be hospitalised for an injury (Australian Institute of Health and Welfare, 2015a), and 1.8 times as likely to die from an injury than non-Indigenous Australians (Henley & Harrison, 2015).

Indigenous Australians are three times as likely to die from chronic lower respiratory diseases and twice as likely to die as a result of self-harm (suicide) than non-Indigenous Australians (Australian Bureau of Statistics, 2016).

Compared to non-Indigenous Australians, Indigenous Australians demonstrate higher age standardised death rates for a number of illnesses and injuries (Australian Institute of Healthand Welfare, 2015c).

Indigenous Australians also experience higher prevalence rates of communicable diseases compared with non-Indigenous Australians, including shigellosis (2.6 times greater), pertussis (whooping cough) (54.3 times greater), and tuberculosis (6 times greater) (Abdolhosseini, Bonner, Montano, Young, Wadsworth, Williams, & Stoner, 2015).

Similarly, life expectancy is lower and mortality rates are higher among Indigenous Australians compared to non-Indigenous Australians.

In 2010–2012, the estimated life expectancy at birth was 10.6 years lower for Indigenous males (69.1 years) compared to non-Indigenous males (79.7 years) and 9.5 years lower for Indigenous females (73.7 years) compared to non- Indigenous females (83.1 years) (Australian Institute of Health and Welfare, 2015c).

Fatal burden of disease studies have also demonstrated the existence of health inequalities— the fatal burden of disease and injury in the Indigenous population is estimated to be 2.6 times that experienced by non-Indigenous Australians, with injuries (22%) and cardiovascular disease (21%) contributing the most to the fatal  burden of disease for Indigenous Australians (Australian Institute of Health and Welfare, 2015b).

Press Coverage : Rural and remote Australians remain deeply concerned about poor access to healthcare, and want the Federal Government to spend more to fix the problem.

That is the key finding from the latest Royal Flying Doctor Service (RFDS) research, released last week as reported ABC

The RFDS surveyed more than 450 country Australians, and one-third nominated access to doctors and specialists as their single biggest healthcare concern.

A third of respondents called for more government funding of services, particularly for mental health and preventative care.

RFDS chief executive Martin Laverty said it raised a question for governments as to whether policies aimed at bridging that gap had failed.

“We have an oversupply of doctors in this country; the problem is, the doctors are simply not all working in areas where they’re most needed,” he said.

“It brings into question the success of repeated programs of Commonwealth governments to encourage doctors to work in remote and country Australia.

“The question for government is, are our incentives for doctors sending them to where they’re most needed?”

Access to doctors in remote areas a challenge

The survey found encouraging news in other areas.

Two-thirds of respondents said they needed to travel for one hour or less to see their GP or another non-emergency medical professional.

But for Australians living in more remote places, a visit to the doctor could mean a 10-hour round trip or more.

RFDS chief medical officer in Queensland Abby Harwood said governments could do other things to improve their access to care beyond putting more bodies on the ground.

“There is a lot of telephone and email consultation going on between people out bush and their GPs, but that requires actually having a pre-existing relationship with a healthcare provider who knows you,” she said.

“Technology such as video-conferencing is a fantastic opportunity, [but] currently the telecommunications infrastructure out in these areas is not quite sufficient to be able to do that reliably.”

GPs not paid by Medicare for teleconference consultations

Unlike specialists, who can bill Medicare for video-conferencing consultations with patients, GPs currently are not paid unless their patient attends a consultation in person.

Dr Harwood said that meant GPs who assisted remote patients over the phone or by teleconference were doing so on their own time and usually out of their own pocket.

“From my experience, most of us would just do it [for free] out of the service that we provide,” she said.

“At the moment it’s either the healthcare provider doing it for free, or the person accessing the GP is paying for it out of their pocket with no subsidy.

“When you consider the petrol bills, how much it costs in fuel to drive a 1,000km round trip, a lot of them would rather pay out of their own pocket to do that [if the doctor is not already doing it for free].”

Dealing with issues before crisis point

Dr Harwood seconded the call for a greater focus on preventative care for rural and remote patients, who were too often only dealing with medical issues once they had reached crisis point.

She said changing that made medical and economic sense.

“[When there’s a crisis] a patient then has to travel in and out of their regional centre or capital city, which obviously causes a lot of disruption and it’s expensive,” she said.

“I don’t think anyone has actually measured the full cost to Australia as a country, taking into account that social dislocation and the economic disruption when people need to leave their properties, leave their workplace.

“It’s been proven over and over again that good primary health care, delivered to people out there on the ground, can often prevent those crises from happening.”


Significant boost in GP numbers ‘in all areas’

Assistant Minister for Health David Gillespie, who has responsibility for regional health issues, is on leave.

But in a statement, a federal Department of Health spokeswoman said there had been a significant boost in GP numbers “in all areas of Australia” over the past decade.

“A 2017 budget announcement included funding of $9.1 million over four years from 2017-18 to improve access to mental health treatment services for people in rural and regional communities,” the statement read.

“Currently, Medicare provides rebates for up to 10 face-to-face consultations with registered psychologists, occupational therapists and social workers for eligible patients under the Better Access initiative.

“From 1 November 2017, changes to Medicare will take effect so that seven of the 10 mental health consultations can be delivered through online channels [telehealth] for eligible patients, that is, those with clinically diagnosed mental disorders who are living in rural and remote locations.

“Relevant services can be delivered by clinical psychologists, registered psychologists, occupational therapists and social workers that meet the relevant registration requirements under Medicare.”