At a lecture at Notre Dame University in Sydney just before the federal election, a medical student asked me if Labor’s promised broadband investment would be taking funds away from the health sector.
My answer was along the lines that providing equitable access to broadband should be seen as a health investment — and not just because of its potential to deliver health services and education.
Broadband’s importance for a population’s health also lies in its ability to connect individuals and communities, and to disseminate information (and thus, as the saying goes, power).
Broadband has rapidly become an essential service, whether for government, businesses, the community sector, or citizens wanting to participate in the new digital world. If you ain’t got it, you are missing out on an important determinant of health, in an economic and the usual sense.
Before metropolitan-based media and interests start protesting about the cross subsidisation of regional access to broadband, let’s not forget that so much public spending and so many government programs are already directed at the better off.
One of the most blatant examples of this from the health sector has been the billions of dollars that have subsidised the private health insurance industry. This spend has not been good value for those living outside big cities, or those disadvantaged groups who often have the greatest health needs (and are least likely to end up in private hospitals).
Similarly, those who live in the well-heeled metropolitan suburbs have been relatively well served by the fee-for-service system that underpins our health care. But this financing model has also contributed to inequities because it means that health dollars tend to follow doctors and where they choose to live and work, rather than the population’s health needs.
And let’s not forget Australian Institute of Health and Welfare estimates that about 4600 more people die each year outside the major cities than if those areas had the same death rates as the major cities. Yet concerns about health inequities have been lamentably absent from the health reform agenda in the past few years.
On the other hand, let’s also not forget that inequities in health funding and outcomes are not only systemic for those in regional Australia. There are plenty of urban poor and people living in the sprawling metropolitan fringes who don’t have affordable access to health care or the sort of living and working environments that promote health and wellbeing.
And if we are to move towards closing the gap in indigenous health, we need to focus broadly, not only on regional Australia. ABS figures show that about one-third of indigenous Australians live in major cities, and a further 21% in inner regional areas.
So, yes, let’s address inequities but let’s do it across the population — and try to ensure that our health spend is according to the community’s health needs, rather than simply writing out blank cheques for hospitals.
Perhaps the section of the agreement between Labor and the two independents, titled “stronger framework for regional policy”, is a first step towards such an approach. Perhaps the plan for a myregion.gov.au website, to enable us to see how resources and programs are being allocated across the regions, is something that could eventually be extended more widely.
Necessity being the mother of invention, it wouldn’t be the first time that under-served areas have led the way.
Gordon Gregory, executive director of the National Rural Health Alliance, is hopeful that the new politics will result in greater fairness all round.
He says: “The work of the NRHA is based on notions of social justice and equity and we recognise that there are many people in metropolitan areas who, because of low income, disability, isolation and chronic illness are very poorly off. Hopefully the current situation is one in which rural and regional people can again be at the forefront of work to produce a fairer Australia all round — partly due to the ‘new paradigm’ reflected in parliamentary change.”
Meanwhile, the agreement suggests that the national health reform agenda will proceed.
The challenge now is to ensure that these reforms are responsive to the needs of local communities — rather than political, bureaucratic, institutional, commercial or professional imperatives. And not only in regional Australia.
*Declaration: Melissa Sweet lives in a rural area and wouldn’t be able to work as a freelance journalist without access to broadband.
While considering access to medical services outside of capital cities, there is one more elephant in the room that needs to be considered.
A huge majority of doctors choose to live in the largest half dozen cities in the land, creating such an imbalance that even residents of relatively large rural communities are under-serviced and smaller communities have no doctor or physiologist or radiographer at all. In fact, the clustering in cities leads to a large percentage of GP’s bulk billing and makes it reasonable for their patients not to privately insure.
Outside of these central locations, bulk billing is rare and charging over the recommended fee is common.
Why are not the numbers of health service providers limited by postcode, so that practitioners may choose between practising in an area with available provider numbers, or be required to purchase via a marketplace the right to hang their shingle in more sought-after locations?
This is not communism or government takeover. Those who seek to be paid by the government, via bulk billing or via medical benefit rebates or other subsidised fee structures must be responsive to signals from the paymaster. The most appropriate way to do so is via the marketplace.
Availability of high speed broad band connectivity will enhance the prospect of a more geographically diverse medical profession being more effective – it works both ways. Think not only of centralised specialists peering at remote images from the bush. Envisage a GP or surgeon in a regional location being able to obtain the collaborative input necessary to improve diagnosis and health management in all its phases, as well as being able to update his/her technical knowledge and to partake in symposiums via efficient distance learning techniques.