Equitable patient access to primary healthcare in Australia
Equitable patient access to primary healthcare in Australia Report
- Author(s): Gardiner, FW, Bishop, L, de Graaf, B, Campbell, JA, Gale, L, Quinlan, F
- Published: 2020
- Publisher: Royal Flying Doctor Service of Australia
Abstract: Rural and remote populations have poorer health outcomes and lower levels of access to healthcare. People living in these areas are frequently required to travel, sometimes significant distances, to inner regional areas and major cities to access comprehensive primary healthcare services. There has previously been little research that determines if there is equitable access to primary healthcare for patients with an equal need in rural and remote as compared to other areas of Australia. Equitable access requires the provision of care of equal quality to everyone. Age, gender, Indigenous status, income, geographic location or any other demographic variable should not result in poorer access to care. Equity in healthcare ensures equal access for those with an equal need; equal utilisation for those with an equal need; and equal or equitable outcomes, often measured by quality-adjusted life expectancy.2 Equitable access can therefore be measured by reviewing population health outcomes, such as mortality comparisons between different population groups. This report finds that rural and remote populations are a high needs population, and identifies specific locations where there is inequitable access to primary healthcare services - general practitioners (GPs), nursing, oral health, mental health and Aboriginal Health Services. This report also considers reasonable access to healthcare: the fulfilment or obtainment of health services in a timely, accessible, affordable and culturally appropriate manner. There is currently no agreed, comprehensive definition of what otherwise constitutes reasonable access to healthcare, including the maximum distance a person should be required to travel to access healthcare, and the type and frequency of health services that should be accessible to a person within this travel distance. This is problematic for many organisations delivering healthcare to people living outside of major cities, such as the Royal Flying Doctor Service (RFDS), who strive to provide high-quality, culturally appropriate healthcare in a timely manner. In the rural and remote context with small populations spread across large geographical areas, it is not realistic for everyone to have access to permanent, local services. However, all should have reasonable access to services. The Australian Institute of Health and Welfare (AIHW), proposes a patient’s ability to access primary healthcare within 60 minutes of motor vehicle travel as one measure of reasonable access. This report adopts this measure and contends that to achieve reasonable or equitable access to primary healthcare, people should have, at a minimum, GP, nursing, oral health and mental health services accessible within 60 minutes. Access in this regard could include the ability to utilise permanent services, visiting or ‘fly-in fly-out’ services within 60 minutes, and have timely access to telehealth services as part of an integrated suite of services. This report finds that 42,805 Australians, or almost 10% of people living in inner regional, outer regional, remote or very remote Australia, had no access to any primary healthcare services within a 60-minute drive time. Through the Stronger Rural Health Strategy, the Commonwealth Government has committed to ensuring “a sustainable, high quality health workforce that is distributed across the country according to community need, particularly in rural and remote communities”. This report identifies areas of highest need, being populations and locations without access to primary healthcare services within a 60-minute drive time, and recommends that these should be addressed first. Future work should be undertaken, as a priority, to develop a more comprehensive definition and baseline measure of what constitutes equitable and reasonable access to primary healthcare. In addition to the 60-minute drive time, consideration should be given to other physical accessibility factors as well as the financial affordability, cultural safety and acceptability of services. Establishing such a minimum benchmark would be of immense value to policy makers, funders and service delivery organisations to provide a common reference point for the services Australians should reasonably expect to receive, no matter where they live. The need for equitable access has been further highlighted during the COVID-19 pandemic. Many of the severe COVID-19 patients internationally have been reported to have an underlying history of hypertension, diabetes, coronary heart disease, COPD, and renal disease. Remote and very remote populations have higher rates of these conditions making them more vulnerable populations if infection rates increase in these areas. Simultaneously, these populations have poorer access to primary health care and preventative services. Reducing the incidence of comorbidities by ensuring reasonable and adequate access to comprehensive primary health care would lower these risks.
- Urls: https://files.flyingdoctor.org.au/dd/files/RN081_Equitable_Health_Research_Report_P4_Digital.725b.pdf
- Publisher Location: Canberra