Reform of Federation and Rural Health

Rural Health Advocate Irene Mills AM Shares Her Wisdom

Reform of Federation and Rural Health

There has been discussion for some years on a funding model that would promote a ‘federal’ approach to health care – moving away from the current situation where three levels of Government  are involved in health (Federal, State and Local), not to mention the myriad of non-government providers.  On the surface, it may seem that the shift to a ‘one Government’ provider would  reduce duplication and cost/blame shifting but don’t think we can be so quick to dismiss such providers , as I believe they all have  a role in health today.

It’s the ‘who’ that is the key when we ‘locally’ are seeking access to health services.  We must acknowledge that while having health ownership closer to home would be the ideal outcome, the reality is there currently is no national or state mechanism at a local or regional level with the expertise or ability to administer/manage the multi-billion dollar health services to communities, especially in rural regional and remote Australia, other than the established state health authorities.

On the face of it, having one funder and supplier delivering a number of shared health services across the country, may seem like the most logical solution, but  how do you get around the inevitable  cost shifting and a ‘blame game’ that  happens whenever there are shared services?

We already see this playing out across rural, remote and regional Australia, where the further away from the funding source you are, the less likely you are to have access to federally funded programs incorporating mental health, aged care and primary care.

We only need look at the wide variation in primary care service delivery (or lack of in many instances) and the muddle created by the establishment of Medicare Locals, which will be replaced by Primary Health Networks (PHN) from June 30 this year. In a move that clearly highlights the risks of a ‘one size fits all approach’ to health,  has recently occurred in my home state of WA, where  it has been decided that there will only be one Network for all of the areas outside the metro including the Kimberley and Pilbara and south west land division. That’s over a third of the Australian land mass with many isolated small communities and aboriginal settlements. What a management nightmare, not to mention the headache sure to come when service delivery efficiency is put under the spotlight by boffins in Canberra

A variety of Primary Health services in communities is key to reducing hospital admissions by keeping the community healthier, and saving lives by reducing the incident of chronic diseases.

If all funding, control and ownership is to come through one Government, it is a major policy change and way of doing business, and rural and remote communities must be assured that change does not mean accessing health services will become even more difficult than they are now. As rural women, we need to examine any proposed policy changes with a rural lens, to ensure that change is not detrimental to rural communities, remembering that one size does not fit all.

We need to continue asking questions as the Federation Reforms are considered.  Questions like:

  • Will changes to funding control create better health services for all Australians?
  • Will it benefit rural regional and remote Australia?
  • Will we be better off and have improved access?
  • Will access be easier and with greater flexibility?
  • Will there be more funds for delivering services to people and less administrative or bureaucratic expenses?
  • Will it be easier to overcome some of the barriers to service delivery in rural areas?
  • Will there be a smoother pathway for recruitment and retention of a health workforce?
  • Will there be credible support to the health workforce in RRR areas?
  • Or Infrastructure with less bureaucracy and dollars spent on administration?
  • Most importantly we need to hear from communities who that they would see as the primary funder and deliverer of health to their community

As rural people, we must be involved in any changes to the way we access health services.  You are urged to get involved in the Federation Process in 2015, as the Green Paper will be released in the first half of 2015 and the White Paper by the end of 2015.

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