The Federal Budget delivered by Treasurer Joe Hockey on Tuesday 13 May was the first clear marker of the Government’s approach to rural and remote health.
The Alliance’s initial media release, Rural election commitments met in ‘medical budget' acknowledged the rural initiatives to which the coalition committed in the context of the 2013 election campaign. As widely expected, there will be no additional new investment.
The Alliance is continuing its analysis of the 2014 Federal Budget and ways to ensure that rural people are considered as the measures are finalised. The most recent in the series is the discussion paper Ensuring that new Primary Health Networks will work well in rural and remote areas.
In the lead-up to the Budget the Alliance emphasised the importance of not applying across-the-board cuts to essential services, on the grounds that such changes are regressive (in terms of an individual or family's ability to pay) and are certain to impact most severely on those who are already vulnerable.
Some of the savings measures, such as those relating to unemployment benefits, tertiary education fees, and increases in the age pension will certainly have the greatest consequence for those who are already in need. The Opinion Piece Measuring the fairness of the Federal Budget for rural people considers a range of these measures. It is to be hoped that consideration will be given to fairer targeting and the operation and structure of safety nets will be monitored and adjusted to ensure that these people are adequately protected.
The seven dollar co-payment for bulk-billed visits to the general practitioner and for pathology and diagnostic imaging can be viewed through the same lens. It is those whose access to a GP is already marginal (in the sense of only just being affordable) who will be the ones to put off going to see a doctor. A new piece of work demonstrates that - yet again - it would be people in rural and remote areas (and their GPs) who would be most affected if co-payments were to be introduced across the board.
This would exacerbate existing disadvantages. Whereas 17 per cent of people in Major cities had skipped a medical service or medication in the past year for this reason, the percentage increased with remoteness to over 20 per cent in regional areas and to almost 35 per cent in remote areas.
It is a matter of concern to the Alliance that, in all of the debate about the universality of Medicare and the impact of increased copayments for access to a doctor, little or no thought has been given to those who are worst off when it comes to such access. These are the people who have no local GP at all.
People in more remote areas may well benefit in the long term from medical research – and the Medical Research Future Fund – but a more urgent priority is to find and use the evidence about how primary care and other health-related services can be better delivered where there is no GP.
Announcements in the 2014 Federal Budget will result in significant rationalisation of agencies in the national health portfolio. It will include the amalgamation of six bodies into a single new agency and the absorption of the functions of three other agencies into the Department of Health. The paper Rationalisation of agencies in the Federal health portfolio summarises the Government's intentions and speculates about the potential impact on health services provided in rural and remote areas.