Rural and remote Australians missing out on the Medicare dollar

Australia’s Medicare dollar is being unevenly distributed across the country, with significantly less funding flowing to people in areas where the disease burden is highest, a new report from Victoria University’s Mitchell Institute shows.

The Is Medicare Fair? series of reports shows that for every Medicare dollar spent on people in the city, 94 cents are spent on people living in outer regional Australia, just 75 cents for those living in remote Australia and 56 cents in very remote Australia. Inner regional people fair slightly better receiving $1.04 cents.

The report also highlights that the Medicare dollar is not being spent where it is most needed. Northern Territory and Tasmania have the highest disease burden in the country, but are missing out on $82 million and $30 million of their share in Medicare funding respectively. While outer regional and remote Australia are missing out $269 million despite having a higher disease burden.

Associate Professor Melinda Craike from the Mitchell Institute at Victoria University said location of specialists and rising out-of-pocket expenses were driving the inequity of access to healthcare.

“Our specialists are primarily located in inner city areas, so rural and regional people need to travel long distances to access services, which is a barrier in itself,” she said. “Rising out of pocket fees charged by specialists is also restricting access for low income Australians, many of whom live in rural and remote areas, while allowing those who have or can find the money to access the healthcare they need.”

Assoc. Prof Craike said there were some easy solutions that could be implemented quickly to go towards addressing the problem.

“We need a large investment in telehealth to allow rural and regional patients to speak to specialists without needing to travel,” She said. “It needs to be a national systematic program not implemented in an ad hoc way which is the case at the moment.”

She said specialist Medicare provider numbers could be allocated by location.

“This would encourage specialists, particularly graduates, to work in rural Australia rather than be located solely in our capital cities.”

More broadly, the Government needs to establish a taskforce to consider how we can make healthcare more accessible for all Australians and in particular address the growing specialist gap fees, over and above the Medicare payments, which is making healthcare cost prohibited for low and middle-income Australians.

“There is increasing pressure on our hospitals to treat acute and chronic conditions which could have been managed and treated in the community before they escalate to an emergency.”

Almost 50,000 more Australians on lower incomes die each year from chronic diseases – such as diabetes, heart disease and cancer – before the age of 75, compared to those on higher incomes.

“Australia prides itself for having a healthcare system for all, believing that people don’t end up with poor health or early death because they can’t afford healthcare. But this report clearly shows our system is failing to provide this, benefiting the wealthy and it is overdue for reform.”

She said the public system is very good at responding to trauma and acute conditions in our emergency departments, but it is not able to respond to the high rates of chronic illness that now affects one in two Australians.

“A third of chronic disease is preventable – yet less than 1.3% of our healthcare budget focusses on disease prevention. We need to shift our focus to disease management and prevention,” A/Prof Craike said. “At the moment clinicians are paid to treat the disease. We need a system where they are paid to treat the whole patient which can include preventing illness in those that have risk factors such as obesity, poor diet or limited exercise. Medicare funding should provide for multidisciplinary and continuing treatment for people with chronic conditions.”