Dying three years younger is the price of poor health services in the bush

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THE massive divide in health resources between our cities and rural areas is extracting a deadly price – if you live in the bush you’ll die three years earlier.

Hundreds of millions spent on GP incentive payments, scholarships and mandatory work requirements to attract doctors to the bush have made little difference to health outcomes.

A News Corp investigation has found up to 10 per cent of Australia’s cancer patients die earlier than they should simply because they live in the bush.

Rural residents are more likely to have cancer, diabetes and heart disease. They are more likely to smoke, be obese, and have high cholesterol but they wait longer to see a doctor and are less likely to be bulk billed.

The National Rural Health Alliance has quantified the cost of the health inequity at $2.4 billion a year.

Rural residents get 12.6 million fewer Medicare services, 11 million fewer prescription medicines and $800 million a year less dental and allied health care.

As a result they are 30 per cent more likely to end up in hospital as a result of an avoidable cause than people living in cities.

This inequality in spending and services has a calamitous human impact that is cutting short the lives of those who life outside our capital cities.

Data from the National Health Performance Authority shows the life expectancy of someone who lives in a major city is 83 years. If you live in the bush it’s nearly three years less – 80.6 years.

Rural Doctors Association president Dr Ian Kamerman says city residents who have bulk-billing GP clinics on their suburban corners, hospitals and imaging services within a few kilometres drive have no idea how difficult just getting a diagnosis in the bush can be.

Some rural residents have to wait up to six weeks just to get in to see their GP, he says.

The doctor will order some tests but a shortage of sonographers means a wait of up to a month for an ultrasound.

If an MRI or a CAT scan is needed the patient may have to travel to another town and also face a wait of around a month.

In Brisbane you can get to a hospital outpatient clinic and see a specialist for free, in the bush you’d have to travel to a major city or pay a $200 gap to see a private specialist.

Queensland’s Patient Travel Subsidy Scheme (PTSS) will pay 30 cents per kilometre for travel to the nearest specialist and an accommodation subsidy of $60 per person per night when staying in commercial accommodation.

Then, if they have a cancer diagnosis, patients face the prospect of leaving their farms and their families for weeks at a time to obtain radiotherapy treatment in a major city.

“I have patients who say they couldn’t do that, they couldn’t be away from home,” Dr Kamerman says.

“They end up having less effective treatment, they have poorer outcomes,” he says.

In Queensland 1998-2007 a study estimated that 470 (8 per cent) premature deaths due to colorectal cancer and 170 (7 per cent) premature deaths due to breast cancer could be attributed to the fact the patient lived in a rural area.

A Medical Journal Australia article this month found men living in rural areas had a poorer survival rate from prostate cancer and 10 per cent or 709 deaths “could have been avoided if the urban-rural disparity was eliminated” during 1992-2007.

 

INCENTIVES FAIL, ONE DOCTOR TO THE BUSH IN NINE YEARS

Governments have poured $5.2 billion into fixing the rural health crisis since in the last 15 years but improvements have been slow.

Despite a scheme forcing foreign doctors to work in the bush and more than 50 expensive incentive schemes to keep doctors in rural towns there are half as many medical practitioners per 1,000 population in the country compared to the city.

Governments have set up new rural medical schools and encouraged rural students to train in medicine in the hope they may be more likely to stay in the bush when they graduate.

However, still more than 40 per cent of doctors working in rural areas are foreign trained.

A bonded medical scheme that paid scholarships to 25 per cent of medical students to boost the rural workforce has delivered just one new doctor to the bush after nine years, three other students bought their way out of their obligation.

A telehealth system introduced by the previous Labor government that pays specialists who consult with patients in rural areas via video consultations over the internet has helped 40,000 patients and delivered 71,000 services in 2012-13.

However the program is underperforming, with just one fifth of the forecast money spent in 2012-13 and only 12 per cent of the nation’s specialists taking part in the scheme.

The Rural Health Alliance says problems accessing fast internet speeds in the bush is a major issue for the program.          

Rural Doctors Association president Dr Ian Kamerman says the May Budget will make matters worse for the bush because it has “multiple arrows hitting the same target – GPs”.

When medical courses triple in cost graduates won’t work in the Budget because they won’t earn enough to pay off their debt, low income country patients will find it harder to pay the $7 GP fee and the closure and other changes will make it less attractive to take on GP registrars in the bush.

Rural Health Alliance’s Gordon Gregory says it is time to move away from the fee-for-service model for practices in more remote rural areas and pay doctors that work there a salary.

This model is used in Queensland with doctors receiving a salary from the state government but also given the right to practice privately to earn extra income.

A Grattan Institute report last year said the solution to the crisis was to allow pharmacists in the bush to write repeat prescriptions for a drug the doctor has already prescribed, and deliver vaccinations.

It also suggests producing an army of three-year-trained physician assistants who, working under a GP, could order blood tests, X-rays and write prescriptions to ease the rural workforce shortage.

Source: Daily Telegraph