Avoidable hospitalisations: another rural health care deficit

08 November 2013

People in rural areas are more likely than those in cities to end up in hospital for reasons that could have been avoided by more effective primary care. In 2011-12, Central and North Western Queensland Medicare Local region had the highest rate of avoidable hospitalisation, at 5,342 per 100,000 people, compared with 1,891 in North Sydney.

The main reason for higher rates of avoidable hospitalisations in rural areas compared with metropolitan and regional catchments is the relative absence of access to primary care (GPs, community nurses, pharmacists, dentists, physios). The NRHA has published earlier work assessing the primary care deficit in rural and remote areas at a staggering $2.1 billion a year.

The report by the National Health Performance Authority (NHPA) released this week shows that for 21 conditions, the age standardised rates of potentially avoidable hospitalisations were almost three times higher in some local areas compared with others. Hospitalisations for worsening conditions that could have been managed earlier impose significant extra costs on Australia's health system and expose patients to unnecessary risks.

The NHPA's report is at pains to emphasise that the rates vary substantially within peer groups of like Medicare Locals. But from the Alliance's point of view, the overall differences between metropolitan and rural Medicare Locals tell the important story. Comparisons with other Medicare Locals in the same peer group are fair enough, but if most of the rural Medicare Locals have poor outcomes, it is cold comfort to be best in the peer group.

The NHPA reports that there were more than 635,000 hospital admissions in Australia for a number of conditions considered to be avoidable. Although the analyses are done by Medicare Local catchment, the information relates to the period before Medicare Locals were established so effectiveness of their work cannot be judged from this information.

Potentially avoidable hospitalisations are those which may have been avoided by timely and effective provision of non-hospital or primary care and include a proportion of admissions due to nine chronic conditions such as asthma, diabetes complications, high blood pressure, ten types of acute admission such as dental problems and throat infections, and all vaccine preventable conditions (eg measles and pneumonia).

The NHPA report, Healthy Communities: Selected potentially avoidable hospitalisations in 2011–12, is available at www.nhpa.gov.au

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Lesley Barclay - NRHA Chair: 0412 282 801