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Redressing Regional-Urban Inequalities in Health Care

Aug 18 2020

By Rizina '22
Hometown: Australia
Major: Sociology and Economics
Undergraduate Research Assistant

Out West Student Blog

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Australia receives significant praise for provisioning a universal healthcare system, one which affords medical access to all Australians, irrespective of their socioeconomic status. Medicare is fundamentally Australian. It reflects our egalitarian ethos, our deep commitment to giving everyone a ‘fair go,’ and our collective responsibility to help the most vulnerable in our society.

Despite its universality, the Australian healthcare system produces significant inequalities. Individuals living in regional areas have substantially poorer health outcomes than their urban counterparts. This is compounded by the prevalence of marginalized groups in regional areas. Aboriginal and Torres Strait Islander (ATSI) people, who live primarily in rural areas, have a life expectancy that is 10.6 years lower for males and 9.5 years lower for females than that of the average Australian [1].

The truth, simple, yet devastating, is that regional Australians have shorter lives. 

At present, there isn’t a strong political imperative to enact the widescale reforms required to change this. However, technology, particularly through the adoption of telehealth services, could redress many of these inequalities. 

Definitions

Telehealth: “The use of telecommunication techniques (most commonly video conferencing) for the purpose of providing medical care and education over a distance” [2]. 

Regional Australia: Regional Australia is defined as all of the towns, small cities, and areas outside of Sydney, Melbourne, Brisbane, Perth, Adelaide, and Canberra. The population of regional Australia is 8.8 million people [3]. 

Business Development Incubator: “A program designed to accelerate the growth and success of entrepreneurial companies through affording business support resources and services, such as physical space, capital, coaching, and networking connections” [4].

Regional Health Outcomes

Healthcare inequalities between regional and urban Australians are attributable to lifestyle differences, educational and employment disadvantage, and of consequence to public policy, lower access to regular, high-quality health care. 

Lifestyle Differences: Lifestyle characteristics, such as whether an individual smokes, eats a healthy diet, exercises regularly, and consumes alcohol in moderation, affect health outcomes, particularly the development of chronic diseases. In regional areas, approximately 1 in 5 people smoke compared to approximately 1 in 10 in urban areas, and less than 50% of people meet the physical activity guidelines in regional areas [5].

Educational and Employment Disadvantage: Education and employment status construct an individual’s socioeconomic status, which subsequently affects their health outcomes. Although universal medical access is provisioned through Medicare, not all services are free, and even subsidized ones can be costly. Further, socioeconomic status affects one’s understanding of and ability to maintain a healthy lifestyle. In 2018, approximately 50% of people living in regional areas had completed high school, compared with 74% in urban areas; In 2016, “Australians living outside of capital cities had, on average, 18% less household income per week, and 29% less mean household net worth” [6].

Lower access to regular, high-quality health care: Economic limitations, combined with the reduced provision of healthcare providers and hospitals in regional areas, lower access to regular, high-quality healthcare. Compared to urban areas, in rural areas, healthcare facilities are smaller, have fewer resources, and provide limited access to specialist healthcare. Thus individuals either accept and access limited healthcare or must travel long distances, which requires time, job flexibility, and economic resources. People living in regional areas are 4.5 times more likely to travel more than an hour to see a doctor than those living in major cities [7].

Technology for Good: Telehealth

Telehealth services are utilised to some extent in Australia. In the quarter ending March 2013, the Department of Human Services had processed Medicare Benefits Schedule (MBS) payments for more than 77, 000 telehealth services. These services were provided to over 33, 000 patients by over 7, 700 practitioners [8]. Comparatively, in the quarter ending June 2016, the Department of Human Services had processed MBS payments for around 475, 545 telehealth services provided to over 144, 000 patients by approximately 13, 815 providers [9]. This represents significant growth in telehealth services, patients, and providers in three years. However, telehealth still represents a small percentage of overall healthcare services. On average, Australians have a doctor’s appointment 6 times a year, which amounts to approximately 150 million appointments, significantly higher than the 475, 545 telehealth services provided in the quarter ending June 2016 [10]. The MBS provides telehealth rebates for people living in regional areas, residential care facilities, using Aboriginal Medical Services, and/or needing a medical specialist. The MBS requires that the patient and specialist are at least fifteen kilometers apart [11]. Financial incentives are also provided to health professionals for transitioning to electronic systems for billing, scheduling, and training.  

In response to COVID-19, the federal government increased Medicare-funded telehealth services, including making telephone consultations available for the first time. They removed geographical constraints and increased the range of telehealth services available. At first, these expanded services were only open to vulnerable patients, such as older Australians and those with a chronic illness. But by early April, these restrictions were lifted, meaning all Australians could access Medicare-funded telehealth. “A small survey conducted by the Consumer Health Forum found 80% of patients offered a telehealth option accepted, and 68% of patients found it better or equivalent to an in-person consultation” [12]. 

Putting 2 + 2 together

Research indicates that telehealth has a number of positive implications, including:

  • Improved quality of care for individuals managing chronic disease
  • Strengthening of local care provider services
  • Increased access, timeliness, and regularity of care, resulting in better long-term health outcomes
  • Cost reduction and allocation of saved funds to better patient management and improved healthcare facilities

These positive implications can effectively rectify some of the inequalities between regional and urban health outcomes. Increased access, timeliness, and regularity of care, in particular, enables individuals to employ a proactive approach in disease management and regular doctor-patient interactions promote healthier lifestyle choices. Thus, telehealth can remove two of the barriers to health inequality. The last, educational and employment disadvantage, requires government action aimed at increasing social mobility and easing access to social capital. 

The early promise of telehealth has led the World Health Organisation (WHO) to conclude that telehealth is integral for creating effective and efficient healthcare systems: “By extending the healthcare system using other communication and collaboration technologies and making the best use of all clinicians and staff in the healthcare system, we can develop a scalable healthcare system that will be a model of the care delivery system of the future” [13].

Of course, there are challenges. Widespread telehealth adoption will require education and training, secure electronic systems for video transmission and the transfer of sensitive medical data, and quality assurance procedures to guarantee illnesses are not missed consequent of the online medium.  

A telehealth business incubator, which supports innovative solutions to these challenges, could be the answer. This would, in fact, be conducive to Australia’s National Telehealth Strategy, developed for discussion in 2017 by Michael Gill, Chair of the Australian National Consultative Committee on Electronic Health. 

The strategy posits the focus areas denoted in the graph below as key for developing Australia’s telehealth capacity, focus areas which can be centralized in a telehealth incubator [14]. 

For example, accuRx, a company which has enabled the mass adoption of telehealth appointments in the UK during the COVID-19 pandemic, was started through Entrepreneur First, a talent investor which helps individuals start their own companies (analogous to a business incubator). Today, “more than 90% of primary care clinics in England are using accuRx’s [telehealth conferencing system]” [15].

Conclusion

Therefore, expanding telehealth services, such as through a telehealth incubator is critical to the prosperity and health outcomes of individuals in regional Australia. It’s an effective solution that doesn’t require enormous financial resources, yet places innovative practices and Australian entrepreneurs at the forefront. 

Empowering every Australian to live a full, healthy life is our moral responsibility.  

Citations

[1] https://www.aihw.gov.au/getmedia/5d39a104-a2d5-4ab5-900c-697ee0e5a1d8/ah16-5-8-main-contributors-indigenous-life-expectancy-gap.pdf.aspx#:~:text=The%20gap%20in%20life%20expectancy%20between%20Indigenous%20and%20non%2DIndigenous,Indigenous%2083.2)%20(Figure%205.8

[2] https://www1.health.gov.au/internet/main/publishing.nsf/Content/e-health-telehealth

[3] http://www.regionalaustralia.org.au/home/what-is-regional-australia/

[4] https://www.abs.gov.au/websitedbs/D3310114.nsf/home/Frequently+Asked+Questions#:~:text=The%20Major%20Urban%20category%20defines,not%20restricted%20to%20Capital%20Cities

[5] [6] [7] https://www.aihw.gov.au/getmedia/918ae1b7-eeaf-4e64-9b88-36b887100a9e/Rural-remote-health.pdf.aspx?inline=true

[8] https://www.ruralhealth.org.au/sites/default/files/publications/nrha-factsheet-ehealth.pdf

[9] http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/connectinghealthservices-factsheet-stats

[10] https://theconversation.com/factcheck-does-the-average-australian-go-to-the-doctor-11-times-a-year-26242

[11] http://mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/connectinghealthservices-eligible-geo

[12] https://theconversation.com/telehealth-in-lockdown-meant-7-million-fewer-chances-to-transmit-the-coronavirus-141041

[13] [14]  https://www.who.int/goe/policies/countries/aus__support_tele.pdf

[15] https://www.nytimes.com/2020/04/04/world/europe/telemedicine-uk-coronavirus.html

 

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