Access to health care

People living in Remote and Very remote areas generally have poorer access to health services than people in regional areas and Major cities. They also have lower rates of bowel, breast and cervical cancer screening and higher rates of potentially preventable hospitalisations (AIHW 2018a, 2018b, 2019a, 2019b).

People living in remote areas of Australia may need to travel long distances or relocate to attend health services or receive specialised treatment. For example, based on combined data for 2005–2010, 57% of people with end-stage kidney disease who lived in Very remote areas at the start of their treatment moved to less remote areas within 1 year (AIHW 2013).

Primary health care

Primary health care is the entry level to the health system. As such, it is usually a person’s first encounter with the system. It includes a broad range of activities and services, from health promotion and prevention, to treatment and management of acute and chronic conditions (AIHW 2016).

The way people in rural and remote areas access primary health care often differs to those in metropolitan areas. For example, facilities are generally smaller, have less infrastructure and provide a broader range of services to a more widely distributed population. Rural and remote populations also rely more on general practitioners (GPs) to provide health care services, due to less availability of local specialist services (Department of Health 2016).

Medicare claims data from 2017–18 shows that the number of non-hospital non-referred attendances per capita were less in Outer regional (6.0 per capita) and Remote and Very remote areas (4.9 and 3.6 per capita respectively), compared with Major cities (6.3 per capita). Bulk billing rates were highest in Very remote areas and Major cities; rates were slightly lower but similar in regional areas (Department of Health 2018) (Table 1).

Table 1: Medicare statistics, non-hospital non-referred attendances, excluding practice nurse items, by area of remoteness, 2017–18(a)(b)(c)(d)

 

Major cities

Inner regional

Outer regional

Remote

Very remote

Number of services

112,015,315

27,742,916

12,273,644

1,431,221

731,445

Number of services per capita(e)

6.3

6.3

6.0

4.9

3.6

Bulk billing rate(f)(g)

87%

84%

85%

85%

89%

Average out of pocket cost for non-bulk billed services(h)

$38.37

$34.73

$35.72

$39.44

$40.59

Source: Department of Health Annual Medicare Statistics 2018. 

Notes

  1. Financial Year is determined by the date the claim for service was processed by the Department of Human Services, not the date the service was rendered.
  2. Medicare services refer to services funded through the Medicare Benefits Schedule (MBS).
  3. Remoteness area is determined by the patient's Medicare enrolment postcode as at the date their claim was processed.
  4. Numbers are based on out of hospital data.
  5. Number of services per capita is derived from the total Estimated Resident Population for financial years based on ABS catalogue 3218.0 Regional Population Growth, Australia, table 1 Estimated Residential Population, Remoteness Areas, Australia, released March each year. ERP used are based on June quarter population. However, there are people in the population who are not eligible for Medicare therefore this number is an estimate. 
  6. Bulk billing is reported on a year-to-date (YTD) basis over the course of the financial year. The bulk billing rates are rounded to whole numbers for reporting purposes.
  7. Bulk Billing Rate represents the percentage of services bulk billed.
  8. Average Patient Contribution Per Service is for patient billed services rendered out of hospital. The number of services is the total number of non-hospital, non-referred attendances, excluding practice nurse items, that were bulk billed or patient billed.

Survey of Health Care: Patient experiences 

Based on self-reported data from the Australian Bureau of Statistics Survey of Health Care, in 2016, Australians aged 45 and over living in regional and Remote and Very remote areas were more likely than those living in Major cities to report barriers to receiving health care. When compared to Major cities, the rate of people reporting not having a GP nearby as a barrier to seeing one was:

  • 2.5 times as high for Outer regional areas
  • 6 times as high for Remote and very remote areas.

The proportion of people reporting not having a specialist nearby as a barrier to seeing one increased from:

  • 6.0% in Major cities to
  • 22% in Inner regional areas to
  • 30% in Outer regional areas and
  • 58% in Remote and very remote areas (Figure 1) (AIHW 2018c).

Figure 1: Patient experiences in adults aged 45 and over, by remoteness, 2016

This horizontal bar chart shows selected characteristics on patient experiences of coordination of health care. It shows that Australians living outside of Major cities were more likely to report not having a general practitioner (GP) nearby as a barrier to seeing one. People in Inner regional and Remote and very remote areas were almost 2 times more likely to have visited an emergency department in the last 12 months because there was no GP available, compared with people living in Outer regional areas and Major cities. The proportion of patients reporting no specialists nearby as a barrier to seeing one, also increased with increasing remoteness. Compared with people living in Major cities, those living in Inner regional areas were 2.2 times more likely to report this barrier. People living in Outer regional areas were 5 times more likely and those in Remote and very remote areas were 10 times more likely to do so.  The proportion of people reporting that their GP was not informed of care received by a specialist, was similar between Major cities and regional areas but, higher in Remote and very remote areas.

Source: AIHW 2018c.

For more information see: Survey of Health Care: selected findings for rural and remote Australians.

Health workforce

Health workforce is measured by the number of full-time equivalent (FTE) health professionals in an area divided by the estimated resident population of the area.

Australians living in Remote and Very remote areas experience health workforce shortages, despite having a greater need for medical services and practitioners with a broader scope of practice (AMA 2017). Data from the National Health Workforce Dataset show that the total clinical FTE for health professionals per 100,000 population generally decreased as remoteness increased. In 2017, the rate of allied health professionals, dentists and pharmacists was lower in regional areas and lowest in Remote and Very remote areas compared with Major cities (figures 2, 3).

The rate of specialists also substantially declined with increasing remoteness from 143 per 100,000 population in Major cities to 22 per 100,000 population Very remote areas.

The clinical FTE rate for nurses and midwives was highest out of all health professionals. The rate declined from 1006 per 100,000 in Major cities to 979 in Inner regional and 944 in Outer regional areas. However, the rate increased in Remote (1103) and Very remote areas (1172) (Department of Health 2019) (Figure 2).

GP supply was also unequally distributed as remoteness increased. Data indicate that the rate of GPs in 2017 increased with remoteness, however, care should be taken in interpreting the data as work arrangements in these areas have the potential to be more complicated (NRHA 2017). For example, there may be poor differentiation between general practice for on-call hours, activity for procedures and hospital work for GPs working in rural and remote areas (Walters et al. 2017).

Figure 2: Employed medical health professionals, clinical full-time equivalent rate, by remoteness area, 2017

Source: Department of Health 2019; Table S6.

Figure 3: Employed allied health professionals, clinical full-time equivalent rate, by remoteness area, 2017

This horizontal bar chart shows the clinical full-time equivalent (FTE) rate of employed allied health professionals per 100,000 population for pharmacists, physiotherapists, psychologists, occupational therapists, optometrists and podiatrists. Overall, the proportion of employed allied health professionals decreased with increasing remoteness. For podiatrists and pharmacists the rate nearly halved when comparing Major cities with Very remote areas. The rate of psychologists steeply declined once outside of Major cities, from 75 per 100,000 to 48 in Inner regional areas, 35 in Outer regional, 25 in Remote and 19 in Very remote areas. While the rate of physiotherapists declined by about one-third in Inner regional areas at 62 per 100,000, and decreased to 51 in Outer regional areas, when compared with Major cities at 93. The rate of physiotherapists continued to decline in Remote and Very remote areas but was fairly similar between these areas. Occupational therapists also declined outside of Major cities. This was more substantial in Remote and Very remote areas. The rate of optometrists steadily declined outside of Major cities from 18 per 100,000 to 7.0 in Remote areas and 4.0 in Very remote areas.

Source: Department of Health 2019; Table S6.

For more information and data see: supplementary tables.

Hospitalisations

In 2017–18, people living in Very Remote areas were hospitalised at almost twice the rate as those living in Major cities and 1.3 times in Remote areas. There was no difference in rate of hospitalisations for regional areas compared with Major cities.

People in Major cities had higher rates of rehabilitation care compared to people living in other remoteness areas (19 hospitalisations per 1,000 population compared with 11 for Inner regional areas, 6.9 for Outer regional areas, 6.2 for Remote areas and 5.1 for Very remote areas). In part, this may reflect the distribution of private hospitals across remoteness areas, as private hospitals accounted for 80% of rehabilitation care separations (AIHW 2019a). For more details on hospitalisations see glossary.

Potentially preventable hospitalisations

Potentially preventable hospitalisations (PPH) are conditions where hospitalisation could have potentially been prevented through the provision of appropriate individualised preventative health interventions and early disease management, usually delivered in primary care and community-based settings.

In 2017–18, the PPH rate increased with increasing remoteness. When compared with Major cities, the rate for those in Very remote areas was 2.5 times as high and in Remote areas was 1.7 times as high. For regional areas the PPH rates were slightly higher than for Major cities (Figure 4) (AIHW 2019a).

For more information see: Admitted patient care 2017–18: Australian hospital statistics.

For more in depth data see: Potentially preventable hospitalisations in Australia by small geographic areas.

Figure 4: Hospitalisations per 1,000 population for selected potentially preventable hospitalisations, by area of remoteness, 2017–18

This vertical bar chart shows the rate of hospitalisations per 1,000 population for selected potentially preventable hospitalisation (PPH) conditions. For each area of remoteness, these conditions included vaccine preventable, acute conditions, total chronic conditions, diabetes complications, chronic conditions excluding diabetes and total potentially preventable hospitalisations. For all types of PPH, rates generally increased with remoteness. For example, hospitalisations due to acute conditions increased from 12 per 1,000 in Major cities to 23 for Remote areas and 30 for Very remote areas. Similarly, the hospitalisation rate for diabetes complications rose from 1.7 per 1,000 in Major cities to 3.0 in Remote areas and 4.7 in Very remote areas. The rate of hospitalisations for vaccine preventable conditions was 3.2 per 1,000 population in Major cities. This decreased to 2.6 in Inner regional and to 2.8 for Outer regional areas. Hospitalisations for these conditions were higher in Remote and Very remote areas at 11 per 1,000. Total PPH rose from 26 per 1,000 in Major cities to between 29 and 32 in regional areas, and 45 in Remote and 66 in Very remote areas.

Note: Hospitalisation rates are directly age-standardised using populations by remoteness areas, which do not include persons with unknown migratory area of usual residence.

Source: AIHW 2019a; Table S7.

References

AIHW (Australian Institute of Health and Welfare) 2013. Chronic kidney disease: regional variation in Australia. Cat. no. PHE 172. Canberra: AIHW.

AIHW 2016. Primary health care in Australia. Canberra: AIHW. Viewed 18 October 2018.

AIHW 2018a. Australia’s health 2018. Australia’s health series no. 16. Cat. no. AUS 221. Canberra: AIHW.

AIHW 2018b. BreastScreen Australia monitoring report 2018. Cancer series no. 112. Cat. no. CAN 116. Canberra: AIHW.

AIHW 2018c. Survey of Health Care: selected findings for rural and remote Australians. Cat. no. PHE 220. Canberra: AIHW.

AIHW 2019a. Admitted patient care 2017–18: Australian hospital statistics. Health services series no. 90. Cat. no. HSE 225. Canberra: AIHW.

AIHW 2019b. National Bowel Cancer Screening Program: monitoring report 2019. Cancer series no. 125. Cat. no. CAN 125. Canberra: AIHW.

AMA (Australian Medical Association) 2017. Rural workforce initiatives 2017. Canberra: Australian Medical Association. Viewed 17 June 2019.

Department of Health 2016. National Strategic Framework for Rural and Remote Health. Canberra: Department of Health. Viewed 17 June 2019.

Department of Health 2018. Annual Medicare statistics. Canberra: Department of Health. Viewed 4 June 2019.

Department of Health 2019. Health workforce data tool. Canberra: Department of Health. Viewed 4 June 2019.

NRHA (National Rural Health Alliance) 2017. Health workforce. Canberra: NRHA. Viewed 25 June 2019.

Walters L, McGraik M, Carson D, O’Sullivan B, Russell D, Strasser R et al. 2017. Where to next for rural general practice policy and research in Australia? The Medical Journal of Australia 207:56–58. Viewed 25 June 2019.