Vic Management Interns' blog

Blog posts by Management Interns of the ACHSM based in the State of Victoria.


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ACHSM Admin

HMIP Victoria Management Interns

The challenges in providing rural healthcare

The challenges in providing rural healthcare

Author: Jass Pannu

1st year intern

In 2018, Australia’s population has been estimated at approximately 25 million, with more than 25% living in regional and rural Australia (Australian Institute of Health and Welfare (AIHW), 2018). According to the AIHW (2017), 75% of the population does not get enough exercise and 69% of the population are considered overweight or obese in rural communities. Moreover, people living in rural communities are almost twice as likely to commit suicide and five times more likely to die from a road accident compared to those living in the city (AIHW, 2017).

Shorter life spans, higher level of disease and injury and poorer access to and use of health services in rural populations are also evident when compared to their metropolitan counterparts. Rural communities also have a higher population of older people due to the migration of the younger generation to the cities for education or employment (Oliver, 2017).

Health care for rural communities is delivered by small regional and rural hospitals, district health services and multipurpose services where patients have access to a variety of health services (Paliadelis, Parmenter, Parker, Giles & Higgins, 2012).  The challenges in providing rural health services can be categorised into funding, remoteness and workforce.

Funding

Australia has a universal health care system, in which public health services are fully funded by the Commonwealth and State Governments with no out-of-pocket expenses for its consumers (AIHW, 2016). Small Rural Health Services are currently block funded under the National Health Reform Agreement (Department of Health and Human Services, 2018). However, growing capital expenditure and service provision costs, compounded by the need to attract skilled staff to rural areas, are financial pressure points for rural health services (Rechel et al., 2016).

Remoteness

Even though many people prefer to getaway for the weekend or school holidays to rural holiday destinations, many of us, prefer to reside within the comforts of a metropolitan lifestyle. This is reflected in the difficulty in recruiting a skilled workforce and the lack of specialists’ access for rural communities. As aptly stated by Rechel el al. (2016), inequities in healthcare access are partly due to geographical distance. Patients living in rural communities often have to travel far to receive specialised care, and health professionals prefer to practice close to home.

The emergence of Telehealth in recent years has improved accessibility to some specialists care within health services and reduced preventable hospitalizations (Rechel et al., 2016). Telehealth has also reduced geographical barriers for rural patients to access high-level care closer to home (Heath, 2017). However, the success of Telehealth is dependent on the competency and confidence of the staff utilizing it.

Workforce

One of the reasons of poor accessibility of services is the lack of a skilled workforce. Staff working in rural and remote communities often experience a lack of peer support, reduced access to professional development and professional isolation which has an impact on recruitment and retention (Rickards, 2011). The health workforce is ageing and the limited exposure to rural health during undergraduate training often hinders the prospect of a health graduate seeking work in rural settings.

Moreover, working in a rural setting with limited management and professional support is not everyone’s cup of tea. Being one of the very few health professionals in the locality requires staff to increase their scope of practice to meet the needs of the local community and respond to emergencies with minimal support (Paliadelis et al., 2012). Another factor to take into account is that when a health professional relocates to a rural setting, professional opportunities for their partners and educational opportunities for their children need to be considered. 

Strategies

To address the challenges in providing rural healthcare, I believe the approach must be multifaceted. Federal, State and Local Governments need to work together proactively to address workforce misdistribution, professional and social isolation.  We need to implement and promote policies which address health promotion and prevention to create healthy communities rather than treat patients when they become unwell. Healthcare needs to become proactive in preventing illness rather than reactive to treating someone when they become ill. Access and inclusion to the local sporting clubs and partnering with nearby localities to organize health promotion and prevention activities can help communities foster stronger regional bonds, create opportunities to engage in local activities and reduce social isolation.

Moreover, partnerships between health services in the same region should also be encouraged to deliver key services to communities closer to home. Given that we live in a world heavily reliant on technology, the uptake of Telehealth should be encouraged to support health professionals to provide optimal patient care and professional development for rural health professionals.

Funding, remoteness and workforce are some of the dominant issues in providing rural healthcare services. However, they are not the only issues. Health inequities in rural and regional Australia are a result of socio-economic disadvantage, which cannot be addressed by increasing funding, or by the provision of a temporary workforce. Sustainability of solutions to address challenges in rural health care provision must also be taken into account to ensure long term health benefits to the community.

For further reading, please refer to the following.

  • Rural Health

https://www2.health.vic.gov.au/hospitals-and-health-services/rural-health

  • Victorian Health Priorities Framework 2012–2022: Rural and Regional Health Plan

https://www2.health.vic.gov.au/about/publications/policiesandguidelines/vic-health-priorities-framework-2012-22-rural-plan

  • Victoria’s State-wide Design, Service and Infrastructure Plan 2017-2032

https://www2.health.vic.gov.au/hospitals-and-health-services/health-system-design-planning/statewide-plan

References:

Australian Institute of Health and Welfare (AIHW). (2016). Australia’s health 2016. Retrieved from https://www.aihw.gov.au/getmedia/f2ae1191-bbf2-47b6-a9d4-1b2ca65553a1/ah16-2-1-how-does-australias-health-system-work.pdf.aspx

AIHW. (2017). Rural and remote health. Retrieved from https://www.aihw.gov.au/reports/rural-health/rural-remote-health/contents/rural-health

AIHW. (2018). Survey of health care: selected findings for rural and remote Australians. Retrieved from https://www.aihw.gov.au/reports/rural-remote-australians/survey-health-care-selected-findings-rural-remote/contents/summary

Department of Health and Human Services. (2018). Small rural health services funding stream. State of Victoria. Retrieved from https://www2.health.vic.gov.au/hospitals-and-health-services/funding-performance-accountability/activity-based-funding/abf-services-streams/small-rural-services

Heath, S. (2017). Strategies for rural patient healthcare access challenges. Retrieved from https://patientengagementhit.com/features/strategies-for-rural-patient-healthcare-access-challenges

McKail, B. (2018). Accessibility and quality of mental health services in rural and remote Australia. Retrieved from https://vcoss.org.au/wp-content/uploads/2018/06/SUB_180604_Rural-and-remote-mental-health-services.pdf

Oliver, D. (2017). Challenges for rural hospitals- the same but different. BMJ, 357. Retrieved from https://www.bmj.com/content/357/bmj.j1731

Paliadelis P, Parmenter G, Parker V, Giles M, & Higgins I. (2012).  The challenges confronting clinicians in rural acute care settings: a participatory research project. Rural and Remote Health, 12. Retrieved from www.rrh.org.au/journal/article/2017

Rechel, B., Dzakula, A., Duran, A., Fattore, G., … Smith, T.A. (2016). Hospitals in rural or remote areas: An exploratory review of policies in 8 high-income countries. Health Policy, 120, 758-769. https://doi.org/10.1016/j.healthpol.2016.05.011

Rickards, L. (2011). Rural health: problems, prevention and positive outcomes. Retrieved from http://www.futureleaders.com.au/book_chapters/pdf/Health/Lauren_Rickards.pdf



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