Health: Regional Australia—A Stronger Economy Delivering Stronger Regions 2018–19
The Australian Government is committed to supporting Australians to live healthy, independent and active lives, wherever they live across Australia.
Location should not be a barrier to accessing high quality health care. A range of measures and assistance are designed to improve the quality of, and access to, health and aged care services for people living outside metropolitan areas.
The Government has worked to improve health outcomes in regional areas and is committed to continuing this effort. These improvements arise from the delivery of services tailored to meet the needs of local communities and improvements in the coverage of the health workforce.
Assistance is provided through general health programs, and programs targeted specifically at regional Australia, where the Australian Government provides funding to address factors that specifically impact on the health and wellbeing of people living in rural and remote communities. In addition, substantial assistance is provided to states and territories through various specific purpose payments, with a significant amount directed towards people living in regional Australia.
The Government continues to provide targeted initiatives and incentives to improve service delivery and the health workforce in rural, regional and remote Australia. These initiatives and incentives have resulted in, but are not limited to:
- tailored services that meet the needs of local communities
- increased accessibility to services
- improvements to workforce coverage and distribution.
The establishment of the National Rural Health Commissioner is an integral part of the Government’s broader agenda to reform rural health in Australia. Emeritus Professor Paul Worley was appointed Australia’s first ever National Rural Health Commissioner on 11 November 2017. His first priority is to develop and define the new National Rural Generalist Pathway. The National Rural Health Commissioner will work with rural, regional and remote communities, the health sector, and across all levels of government to champion the cause of rural practice and better target and address the health needs in rural and remote Australia.
A Stronger Rural Health Strategy
The Australian Government will provide $83.3 million over five years from 2017-18 to achieve stronger rural, regional and remote health outcomes by aligning the distribution of the health workforce to areas of greatest need and building the capability of Australia's medical practitioner workforce. In addition, the Stronger Rural Health Strategy will provide greater opportunities for Australian doctors through better teaching, training, recruitment and retention.
The distribution of the workforce in rural, regional and remote areas will be improved by:
- establishing a Murray-Darling Medical Schools Network to support an end-to-end training continuum for students to study medicine in the region
- creating a new Junior Doctor Training program with a strong focus on supporting training in rural settings, integral to the development of a National Rural Generalist Pathway by the National Rural Health Commissioner
- expanding the Rural Health Multidisciplinary Training Program
- updating the geographic eligibility criteria for rural bulk billing incentives
- a Workforce Incentive Program to provide incentives for general practice to employ allied health professionals and for doctors to practise in non-metropolitan areas
- improving the return of service obligations under bonded medical training programs
- better monitoring and planning for future workforce needs
- supporting the medical training pipeline and better targeting training places to rural Australia.
Measures will be implemented to improve the capability of the health workforce and provide greater opportunities for Australian doctors by:
- introducing new fee arrangements that recognise the additional qualifications of vocationally registered General Practitioners (GPs) and to provide support for existing non-vocationally registered GPs to upgrade their qualifications
- streamlining the GP training arrangements to be provided through the Royal Australian College of General Practitioners and the Australian College of Rural and Remote Medicine for non-vocationally registered GPs to gain vocational recognition
- providing 100 additional vocational training places through the Australian General Practice Training Program from 1 January 2021
- strengthening the role of the nursing workforce in team-based and multidisciplinary primary care service settings and reviewing the nursing curricula used to develop the nursing workforce
- continuing and expanding support for Aboriginal and Torres Strait Islander health professional organisations.
The Government will also improve the delivery and availability of dental, mental health and emergency aeromedical services in rural and remote areas by providing additional funding to the Royal Flying Doctor Service.
Guaranteeing Medicare—Medicare Benefits Schedule Review (Renal Medicine Items)
This component of the measure, Guaranteeing Medicare—Medicare Benefits Schedule (MBS) Review—response to Taskforce recommendations, implements recommendations from the MBS Review and introduces a new MBS item to fund the provision of dialysis services in very remote regions (defined by Modified Monash Model (MMM) 7). It is anticipated that approximately 470 patients will benefit from this at an estimated cost of $34.8 million over four years from 2018‑19. Access to dialysis services is limited in these extremely remote areas. The financial impacts of relocation on the patient, family and health services are currently unquantified, but it has undeniable social, economic and health consequences. Introduction of the new MBS item is expected to have a significant net benefit to Australians living in remote areas, through improved health outcomes and an associated reduction in the economic impact of end-stage kidney disease.
Indigenous health services—improved primary health care
The Australian Government will improve Indigenous health outcomes by introducing a more transparent primary care funding model based on patient numbers, episodes of care, remoteness and need. Greater transparency of funding will make it easier to identify areas of need to achieve stronger health outcomes.
The funding model has been developed in close consultation with the Aboriginal Community Controlled Health Services and will not affect overall funding. It will be gradually implemented from 1 July 2019 in consultation with the Indigenous health sector to ensure resources are directed to areas of greatest need.
Continuation and expansion of support for Aboriginal and Torres Strait Islander Health Professional Organisations
The Australian Government is supporting the work of Aboriginal and Torres Strait Islander Health Professional Organisations (ATSIHPOs). The Government’s investment in ATSIHPOs is increasing by around $1.6 million a year and enables these organisations to continue and expand activities to meet increased demand for their services. Priorities include training and mentoring, developing leadership, strengthening cultural safety, and engaging and supporting students. This benefits Aboriginal and Torres Strait Islander people currently working in health, or studying to take up a career in the health sector. Aboriginal and Torres Strait Islander people will get better access to appropriate, culturally safe health care across the health system, including in regional and remote areas.
A Stronger Rural Health Strategy—guaranteeing rural and remote access to dental, mental health services and emergency aeromedical services through the Royal Flying Doctor Service
The Australian Government will provide an additional $84.1 million to the Royal Flying Doctor Service (RFDS) for four years from 2018-19 to increase the availability of dental care, mental health services and emergency aeromedical services to Australia's rural and remote communities. Additional funding for dental outreach services is extended beyond 2019, and from 1 January 2019, a new Mental Health Outreach Clinic program will provide professional mental health services to areas where there are currently few or none. The measure also increases the Australian Government contribution to ensuring ambulance services are available from RFDS bases.
Patients in rural and remote areas will benefit from increased access to services through this measure.
Supporting Activity in Older Australians
This measure will implement a competitive community grants program to improve access and increase participation in physical activity among Australians aged 65 years and older to improve their overall health and wellbeing. The community grants program will support Australian national sporting organisations, and non-government organisations to develop and implement local, community-based activities which promote physical activity among older Australians.
Activities will specifically encourage older Australians who do not currently participate in regular physical activity including women, Indigenous Australians, people with a disability, and people from rural and remote regions.
Older Australians, particularly those outside metropolitan centres, can find it difficult to access relevant and appropriate physical activities. Leveraging the reach of sporting organisations and other physical activity providers, this measure will improve the connectedness as well as the physical and mental health of older Australians, including in our regional communities.
Increasing Participation in Sport and Physical Activity
The Australian Government will invest $229.9 million over five years from 2017-18 in a suite of sport and physical activity programs to get more Australians more active more often. This will include initiatives for: water and snow safety; grants to sports and physical activity providers to increase participation in physical activity; an expansion of the Local Sporting Champions program; training and resources for community-based sports organisations to improve the safety of sports participation by children; and for the continuation of the collection of quality data nationwide regarding how active Australians are and what motivates them to move. These initiatives will complement a similar physical activity program for older Australians.
One of the key elements will be a competitive funding program open to sport and physical activity organisations, to develop and implement community-based activities across Australia which focus on getting the inactive active and contribute to chronic disease prevention.
Another key element of this measure is the expansion of the Local Sporting Champions grant program which provides support to elite young athletes to help with costs related to competing at a state, national and international level. Young athletes in the regions have greater barriers to attend such sporting competitions. The Local Sporting Champions program will see 3,000 additional young athletes receiving support to attend events, with more support for young athletes in the regions given their greater travel costs. This support will create more opportunities for children in regional areas and will reduce the financial burden on their families in these areas.
This initiative will be delivered in partnership with national organisations capable of delivering to rural and remote locations, where people are less likely to be as active as other Australians. Sport and physical activity can deliver a range of health, social and economic benefits, particularly in rural and regional areas, where clubs and sporting organisations play a vital role in connecting individuals and communities.
Community Sport Infrastructure
The Australian Government is providing $29.7 million in 2018‑19 to establish a competitive community sport infrastructure program to fund small to medium-scale projects to improve existing sport facilities. Infrastructure grants will be available in amounts from $10,000 to $500,000.
The program aims to ensure more Australians have access to quality sporting facilities throughout the nation, encouraging greater community participation in sport and physical activity. Accessible, safe, inclusive and sustainable sporting and physical activity infrastructure is essential to getting Australians to be more physically active. In many regional locations sports venues are under-utilised due to poor lighting, disrepair or inadequate facilities such as female change rooms and toilets.
In many communities, particularly in regional areas, sport plays an important role in promoting social connectedness. Relatively simple improvements to community infrastructure—such as lighting towers and expanded change room and toilet facilities, particularly for girls and women—will greatly increase participation opportunities. This project will support short-term community-led projects in regional and urban communities, complementing existing Government investments through regional development programs.
Extension of Sporting Schools
The Australian Government will continue funding the Australian Sports Commission-managed Sporting Schools Program for the calendar year 2019 with $41.7 million of investment. The program will expand delivery to 500 secondary schools from the 300 secondary schools currently involved, and continuing to provide funding for 5,200 primary schools each year. This extension reflects the success of the existing program and will incentivise schools to embed sport and physical activity into their daily routines.
The program will have a strong commitment to improving sustainable sport and physical activity participation in regional and remote communities, with equity of access a key principle. The program will provide a platform for children in regional and remote areas to participate in regular sport and physical activity that is otherwise not achieved due to reduced access to community sporting clubs and structured physical activity opportunities in these areas.
The Sporting Schools Program has set targets for engaging rural and remote communities, reflecting the distribution of schools nationwide.
Water and Snow Safety Program
The Australian Government will provide an additional $15.5 million over five years from 2017-18 to support the water and snow safety organisations, Surf Life Saving Australia, Royal Life Saving Society Australia, AUSTSWIM, Laurie Lawrence Swimming Enterprises and the Australian Ski Patrol Association to deliver the Water and Snow Safety Program. This program delivers a range of activities and interventions aimed at reducing the incidence of water and snow-related injury and drowning in Australia.
The 2017 Royal Life Saving National Drowning Report indicated that the highest proportion of drownings occurred in a river, creek or stream at 23 per cent, much higher than the second highest location of beaches at 17 per cent. Recognising this important data, the program includes significant investment for inland, regional and rural waterways. It provides funding for water safety education, the river black spot identification program and promoting access to accredited swimming and water safety teachers in rural and regional areas. Funding continues to be provided to Laurie Lawrence Swimming Enterprises for his educational material, aimed at children under five and includes a book about water safety on the farm.
Keeping Children Safe by Reducing Childhood Injuries
The Government will provide $0.9 million over three years from 2018-19 to develop a new National Injury Prevention Strategy that provides a policy platform to support interventions that reduce the risk of injury amongst the Australian population. Children will be a key focus within the Strategy. Noting both the higher rates and the greater level of impact that preventable injury has in rural and regional communities, the Strategy will include rural and remote populations as a key investment area.
Epilepsy Action Response Service
The Australian Government will provide $1.3 million over three years from 2018-19 for the establishment of the national Epilepsy Action Response Service to provide access to high quality information and expertise on epilepsy, especially in rural and remote areas in Australia.
More Support for Rural, Regional and Remote Aged Care
The Australian Government is investing $144.9 million over four years from 2018-19 (plus $5 million in 2022-23 for capital grants) to enhance the viability of aged care providers in rural, regional and remote Australia and improves access to aged care services for older people living in these locations. This will enable older Aboriginal and Torres Strait Islander people to stay close to their family, home or country and receive culturally appropriate aged care services. This measure has two components:
- Funding for building improvement and urgent maintenance, and infrastructure expansion
- Expanding the existing National Aboriginal and Torres Strait Islander Flexible Aged Care Program to improve access to culturally safe aged care services in remote Indigenous communities.
National Rural Health Commissioner and the development of a Rural Generalist Pathway
The Government is providing $4.6 million over four years from 2018‑19 to establish a National Rural Health Commissioner to provide advice on opportunities to reform rural health services, including the development of a National Rural Generalist Pathway for the training of rural doctors. The Commissioner will work with regional, rural and remote communities, the health sector, universities and specialist training colleges and across all levels of government to improve rural health policies and champion the cause of rural practice.
The establishment of the Commissioner is an integral part of the Government’s broader agenda to reform rural health in Australia. His first priority is to develop and define a new National Rural Generalist Pathway. In February 2018, the Commissioner landed a historic agreement between the Australian College of Rural and Remote Medicine and the Royal Australian College of General Practitioners to work together to develop a national framework for a Rural Generalist medical speciality.
The rural health workforce and communities located in rural and remote areas will benefit from the introduction of the Commissioner who will place rural and remote issues at the forefront of government decision making.
Block Funding for Small Rural and Regional Hospitals
The Australian Government is providing approximately $4.0 billion over four years from 2017‑18 in block funding contributions to states and territories to support services provided by small, rural and regional hospitals. This funding ensures rural and regional communities continue to have access to vital public hospital services.
Commonwealth funding of $188.9 million will also be provided for vital hospital upgrades in Western Australia including:
- $158.0 million towards the Joondalup Health Campus expansion
- $10.6 million towards the Osborne Park Hospital expansion
- $20.3 million towards the refurbishment of the Royal Perth Hospital.
Rural Health Workforce Support Program
The Australian Government will provide funding to Rural Workforce Agencies (one in every state and the Northern Territory) to support the rural health workforce in three priority areas:
- Health Workforce Access: to improve access and continuity of access to essential primary health care, particularly in priority areas identified by the Department of Health and through the Health Workforce Needs Assessment process involving a jurisdictional Health Workforce Planning Stakeholder Group.
- Improving Workforce Quality: to build local health workforce capability with a view to ensuring communities can access the right health professional at the right time; and ensuring health practitioners have the right skills and qualifications for their positions.
- Building a Sustainable Workforce: to grow the sustainability and supply of the health workforce with a view to strengthening the long-term access to appropriately qualified health professionals, with consideration of continuity and growing the sustainability of the health workforce.
Rural Locum Assistance Program
The Australian Government will support the health workforce in rural locations by enabling eligible allied health professionals, obstetricians and anaesthetists to access continuing professional development or to take leave for recreation purposes. The Rural Locum Assistance Program also provides an opportunity for urban General Practitioners to experience regional and rural practice by enabling them to undertake emergency medicine training in return for a commitment to undertake a locum placement in regional and rural Australia.
Remote Area Workforce Support
Remote Area Workforce Support supports the remote and isolated health workforce through the Bush Services Support Line, which provides 24-hour access to trained counsellors for remote health workers and their families. CRANAplus also provides educational and professional development programs for the remote and isolated health workforce.
Aboriginal and Torres Strait Islander Peoples Pharmacy Workforce Program
The Aboriginal and Torres Strait Islander Peoples Pharmacy Workforce Program supports Aboriginal and Torres Strait Islander participation in the pharmacy workforce, which in turn provides improved culturally appropriate pharmacy services to better meet the needs of Indigenous communities and patients. It is preferred that applicants for the Aboriginal and Torres Strait Islander Pharmacy Scholarship Scheme are from rural or remote localities, although, this is not mandatory. Sixteen Aboriginal and Torres Strait Islander Pharmacy Assistant traineeships are offered annually, with up to $10,000 available to a community pharmacy that employs and supports a trainee through the course of their studies (up to two years). Three undergraduate or post graduate Aboriginal and Torres Strait Islander Pharmacy scholarships of up to $15,000 per annum are offered annually. The normal course length is four years (students can access up to $60,000 over the period of their degree).
Rural Pharmacy Workforce Program
The Rural Pharmacy Workforce Program aims to maintain and improve access to quality community pharmacy services in rural and remote communities and strengthen and support the rural and remote pharmacy workforce in Australia. It comprises various initiatives designed to recruit, train and retain pharmacists for rural and remote areas, including undergraduate scholarships, intern support, professional development support and an emergency locum scheme. There are 30 Rural Pharmacy Scholarships offered annually of up to $10,000 per annum. The normal course length is four years (students can access up to $40,000 over the period of their degree).
Rural Pharmacy Maintenance Allowance
The Government is providing $16 million annually (until 30 June 2020) for the Rural Pharmacy Maintenance Allowance, which is paid monthly to eligible rural or remote section 90 pharmacies, in recognition of the additional burden of maintaining a pharmacy in rural and remote areas of Australia.
Streamlining Health Workforce Scholarships
The Government is providing funding to deliver greater flexibility and consistency in targeting scholarships to areas of need by streamlining a number of existing scholarship programs into one—the Health Workforce Scholarship Program.
Additionally, a rural return of service obligation is associated with some scholarship types to provide a greater return on the investment. Obligations under the scholarships ensure exposure to practices in rural settings, and to the lifestyle and types of work available, to encourage these healthcare professionals to continue to work in rural areas.
Support for Outreach Health Services
The Rural Health Outreach Program is providing $112.0 million over four years from 2018-19. This program improves access to health services for people living in rural, regional and remote Australia by supporting a range of outreach health activities. Four health priorities are specifically addressed:
- maternity and paediatric health
- eye health
- mental health
- support for chronic disease management.
Services are provided directly to communities by specialists, general practitioners, nurses and allied health professionals. The Rural Health Outreach Program commenced in 2013‑14 following the consolidation of five previous rural outreach programs.
The Government is providing $243.1 million over four years from 2018‑19 to the Royal Flying Doctor Service to deliver primary aeromedical evacuations, primary health clinics, remote consultations and medical chests containing pharmaceutical and medical supplies to remote locations.
Medicare Benefits Schedule—Listing of Photography with Non-Mydriatic Retinal Cameras
Retinal Photography with non-Mydriatic Retinal Camera (RP-NMRC) was listed on the MBS on 1 November 2016 following recommendation by the Medical Services Advisory Committee (MSAC), to encourage uptake in rural and remote settings.
NMRCs are portable and easily transported to rural or remote settings for use by accredited non-medical staff. Photographs can be interpreted remotely, via electronic link/telemedicine, by an optometrist, ophthalmologist or trained reader. MSAC considered listing of RP-NMRC testing for Diabetic Retinopathy (DR) would improve access to eye health services for patients with limited (or no) ability to access local services. MSAC noted the less intrusive nature of the procedure could encourage uptake and early intervention, and access to eye-care services for Indigenous people is likely to improve if services can be delivered within culturally appropriate settings. Further, provision of RP-NMRC within these communities could increase compliance with recommended screening for DR, and also reduce unnecessary travel for those in whom DR is not detected
Two MBS items are available for RP-NMRC—12325 for Indigenous patients and 12326 for non-Indigenous patients. These items are consistent with National Health and Medical Research Centre guidelines regarding recommended frequency of repeat testing in persons of Aboriginal and Torres Strait Islander descent and the general population. In 2017 there were 881 services claimed for 12325 and 632 services for 12326.
Bulk billing of item 12325 was 100 per cent, while bulk billing of item 12326 was 87 per cent. Uptake increased since distribution of NMRCs commenced to Aboriginal Medical Services and mainstream health services with large Aboriginal and Torres Strait Islander patient bases. The Department continues to work with relevant stakeholders promoting utilisation of the service.
Medicare Benefits Schedule—Support for Rural and Remote Registrars
This program enables general practice registrars training on the Australian College of Rural and Remote Medicine Independent Pathway to claim Medicare benefits (at the A1 level 1) for the services they provide whilst training. Australian College of Rural and Remote Medicine is one of two colleges accredited by the Australian Medical Council for setting professional medical standards for training, assessment, certification and continuing professional development in the specialty of general practice. Australian College of Rural and Remote Medicine Fellows receive full vocational recognition for A1 Medicare rebates and may practise unsupervised anywhere in Australia (A1 is a consultation type where there is personal attendance by a practitioner. The personal attendance of the medical practitioner upon the patient is necessary before a consultation may be regarded as a professional attendance).
This program has a positive impact on regional Australia, as registrars training on the Independent Pathway are likely to be providing services in rural and regional areas during their training. The program also leads to Fellowship of the College; the Australian College of Rural and Remote Medicine advises that most of their Fellows choose to practise in rural and remote communities so that they can fully utilise the scope of clinical skills and knowledge they have gained through the Fellowship program.
Investing in Medical Research—Medical Research Future Fund -Advanced Health Research Translation Centres and Centres for Innovation in Regional Health
The Government is providing $75.0 million over four years from 2017-18 to extend the Rapid Applied Research Translation program that supports Advanced Health Research Translation Centres and Centres for Innovation in Regional Health (CIRHs). The CIRHs will ensure a concerted focus on regional Australian Health needs and service improvements. A key element of the investment is improving the health of vulnerable groups, including those experiencing health inequities due to location, cultural of socio-economic disadvantage.
National Health and Medical Research Council (NHMRC) recognises and promotes leading collaborations between health care organisations, academia and research institutions, through the designation of CIRHs. In 2017, NHMRC recognised the first two CIRHs-the Central Australia Academic Health Science Centre and New South Wales Regional Health Partners.
The CIRHs encourage leadership in health research and translation of direct relevance and benefit to regional and remote areas of Australia. The initiative provides NHMRC recognition (not funding) for Centres that are exemplars of collaboration in health and medical research, research translation and research-infused education, training, and health care in a regional and/or remote setting. These collaborations will increase the translation of research into better clinical practices.
Primary Health Networks
Primary Health Networks (PHNs) are a national network of 31 independent, regionally based, primary healthcare commissioning organisations, established to improve efficiency and effectiveness of medical services for patients, particularly those at risk of poor health outcomes and to improve the coordination of care. Seventeen PHN regions have populations where the MMM is classified at six or seven, the most remote areas. All 31 PHNs have populations with regional areas classified between MMM2 (large regional) and MMM7 (very remote). The PHNs are currently contracted for $3.5 billion (from 2015 to 2020).
- PHN functions include planning, integrating and coordinating primary health care services, and the commissioning of services, across their regions.
- PHNs receive funding which includes loading for rurality, Indigenous population and low population density.
- The commissioning model provides opportunities to identify and implement iterative and innovative solutions to local and remote problems, and work within the unique circumstances of different communities.
- PHN Boards are supported by General Practitioner-led Clinical Councils and by Community Advisory Committees. In rural areas some PHNs have established multiple branches of Clinical Councils and Community Advisory Committees to appropriately reflect the diversity of their regions.
- PHNs are aligning planning and designing activities with other funded stakeholders in their regions (for example, Rural Workforce Agency and Royal Flying Doctor services).
Practice Incentives Program
The Government is providing around $1.5 billion over four years from 2018-19 to the Practice Incentives Program (PIP) to support general practice activities that encourage continuing improvement and quality care, enhance capacity and improve access and health outcomes for patients. There are currently 11 incentives under the PIP that focus on eHealth, teaching, Indigenous health, asthma, cervical screening, diabetes, quality prescribing, general practitioner aged care access, procedural services, after-hours access and rural health. A rural loading is paid in recognition of the difficulties of providing care, often with little professional support, in rural and remote areas and to provide access to services which are available through other means to patients in metropolitan and other urban areas.
The rural loading ranges from 15 to 50 per cent (depending on the remoteness of the practice location) and is applied to the incentive payments of practices in rural and remote areas.
After-Hours Primary Health Care Arrangements
The new after-hours primary health care funding model commenced on 1 July 2015 to ensure access for all Australians to primary health care services during the after-hours period. This included:
- a Practice Incentives Program (PIP) after-hours incentive payment to eligible accredited general practices registered for PIP
- funding to Primary Health Networks to support locally tailored after-hours services, including support for ‘at risk’ populations such as those in rural and remote areas ($287.2 million over four years from 2015‑16)
- an after-hours general practice advice and support line for all Australians who do not have access to face to face general practice services in the after-hours period ($42.1 million over four years from 2015‑16).
The Closing the Gap—Pharmaceutical Benefits Scheme Co-Payment Program
This program is providing around $40 million annually to improve access to Pharmaceutical Benefits Scheme (PBS) medicines for eligible Aboriginal and Torres Strait Islander people living with, or at risk of, chronic disease in urban and rural settings. This program lowers or removes the patient co-payment for PBS medicines.
Quality Use of Medicines Maximised for Aboriginal and Torres Strait Islander People Program
The Quality Use of Medicines Maximised for Aboriginal and Torres Strait Islander People Program, funded under the Sixth Community Pharmacy Agreement, complements the Closing the Gap PBS Co-payment Program by funding a range of Quality Use of Medicine support services, pharmacy services and education for consumers and staff of Aboriginal Community Controlled Health Services located in urban and rural areas.
Section 100 Remote Area Aboriginal Health Service Program
The Remote Area Aboriginal Health Service Program, established under section 100 of the National Health Act 1953, aims to address geographic, financial and cultural barriers experienced by people living in remote areas of Australia in accessing essential medicines through the Pharmaceutical Benefits Scheme (PBS).
The program allows for clients of eligible remote area Aboriginal Health Services to obtain medicines directly from the Aboriginal Health Service at the time of consultation, without the need for a normal PBS prescription, and without charge.
Section 100 Remote Area Pharmacy Support Allowance
The section 100 Remote Area Pharmacy Support Allowance, funded under the Sixth Community Pharmacy Agreement, provides an annual financial allowance that supports visits by pharmacists to provide targeted quality use of medicines and medication management support services to remote area Aboriginal Health Services which participate in the section 100 Remote Area Aboriginal Health Service Program. The visits assist in improving health outcomes for clients of remote area Aboriginal Health Services by supporting quality use of medicines at those services.
Improving Access to Medicines—Maintaining Remote Area Aboriginal Health Services Pharmaceutical Dispensing
From 1 January 2018, arrangements were established to enable eligible pharmacists providing PBS medicines that are labelled for individual clients of Remote Area Aboriginal Health Services, to claim an additional payment for this service from the Department of Human Services.
Improving Maternity Services in Australia—General Practitioner Procedural Training Support Program
The Government will provide $8.2 million over four years from 2018-19 for the General Practitioner Procedural Training Support Program, which aims to improve access to maternity services for women living in rural and remote communities by supporting general practitioners to attain procedural skills in obstetrics or in anaesthetics.
The General Practitioner Procedural Training Support Program targets existing general practitioners in rural and remote areas.
Remote Vocational Training Scheme
The Government is providing $26.9 million over four years from 2018‑19 to the Remote Vocational Training Scheme. The Scheme supports doctors practicing in some of Australia’s most remote locations to undertake vocational general practice training. It delivers structured distance education and supervision to doctors completing general practice vocational training, while they continue to provide general practice medical services to remote and/or isolated communities. The training includes weekly tutorials through video and teleconferences, twice yearly education workshops, remote supervision and individualised training advice.
The Scheme supports 22 new training places each year. Since 2015, an annual cohort of 10 registrars has commenced training in Aboriginal Community Controlled Health Services under the Scheme.
Rural Health Multidisciplinary Training Program
The Government is providing $793.9 million over four years from 2018‑19 to the Rural Health and Multidisciplinary Training Program. The program is designed to encourage the recruitment and retention of rural and remote health professionals by:
- providing effective rural training experiences for health students
- developing an evidence base for the efficacy of rural training strategies in delivering rural health workforce outcomes
- supporting rural health professionals to improve Aboriginal and Torres Strait Islander health
- increasing the number of rural origin health and medical students
- maximising the investment of program funds in rural, regional and remote areas for the maintenance of well-supported academic networks to enhance the delivery of training to students to support the provision of medical services to communities.
The program supports a network of 18 rural clinical schools, 15 University Departments of Rural Health, six dental schools that support extended rural placements and 26 regional training hubs. The regional training hubs are part of the Integrated Rural Training Pipeline Initiative and are responsible for better connecting the various stages of medical training—from undergraduate through to prevocational and vocational training—in rural communities. The program also incorporates funding support for the Northern Territory Medical Program and the Indigenous Transition Pathways to Medicine Program.
Funding is also provided for the National Rural Health Student Network, a national, rural health focused, multidisciplinary student network representing more than 10,000 medical, nursing, and allied health students and supporting 28 university rural health clubs around Australia.
John Flynn Placement Program
The Government is providing $15.8 million over four years from 2018‑19 to the John Flynn Placement Program. The program is designed to enable medical students to form a long-term relationship with a community and to gain a better understanding of rural or remote medical practice and non-metropolitan health services. The program supports participating medical students to undertake vacation placements in the same rural, regional or remote community each year over a four‑year period.
Strengthening Medicare—Rural Procedural Grants Program
The Government is providing $75.0 million over four years from 2018‑19 to the Rural Procedural Grants Program. This program enables procedural general practitioners in rural and remote areas to access grants to attend training and up-skilling in emergency and procedural medicine.
National Health and Hospitals Network—Workforce Training Specialist Doctors
The Government will provide $717.1 million over four years from 2018‑19 to the Specialist Training Program. This program, which commenced in 2010, increases the capacity of the private, rural and community health care sectors to provide high quality training opportunities for trainee medical specialists. In 2015 and 2016, 900 training full time equivalent places were funded, this increased to 950 places in 2017 and 1,077 places in 2018, following the announcement of funding for 100 new dedicated rural training places in December 2015 and the program's consolidation with the Emergency Medicine Program. Around 45 per cent of current training places include a rural component.
National Partnership Agreement on Rheumatic Fever Strategy —continuation and expansion
The Government is providing funding of $18.8 million over four years from 2017‑18 to the Rheumatic Fever Strategy. The strategy supports the prevention and management of acute rheumatic fever and rheumatic heart disease in Indigenous communities, including those in regional and remote areas, through:
- the continuation of state-based register and control programs to improve detection, monitoring and management of acute rheumatic fever and rheumatic heart disease in the Northern Territory, Western Australian, Queensland and South Australia
- new, focused prevention activities in high-risk communities, to prevent the initial incidence of acute rheumatic fever.
This measure also continues the focus on activities aimed at improving clinical care and secondary prevention, such as education and training through RHDAustralia at Menzies School of Health Research. It also strengthens the data collection system through its transfer to the Australian Institute of Health and Welfare.
Elimination of Trachoma in Indigenous Communities—extension
The Government is providing funding of $20.8 million over four years from 2017‑18 to affected states and territories for the elimination of trachoma in Indigenous communities. Trachoma continues to be a significant problem in hotspots in remote Indigenous communities in the Northern Territory, South Australia and Western Australia. Continued investment in these jurisdictions supports screening and treatment of children and provides an increased focus on health hygiene and efforts to improve environmental conditions. Monitoring will continue in Queensland and New South Wales.
Trial of Health Care Homes
This measure will support the Stage one trial of Health Care Homes in up to 200 general practices and Aboriginal Community Controlled Health Services across Australia, including rural and remote regions. A total of $21.3 million has been allocated to support this measure from 2016-17 over four years to better support patients with chronic and complex illnesses, reducing the risk of hospitalisation. This is in addition to $93.3 million in re-directed funding from the Medicare Benefits Schedule for three years from 2017‑18. Participating practices are located across 10 Primary Health Network regions, including rural and remote areas.
With many aspects of the Health Care Homes model already in place in regional and remote general practices and Aboriginal Community Controlled Health Services across the country, this measure will support them to formalise their approach and build on local innovative solutions.
An evaluation of the impacts of the trial will be conducted and an interim report considered in 2019, with a final report due in 2020.
The Australian Government’s Response to the National Ice Taskforce Final Report
In response to the findings of the National Ice Taskforce, the Government is providing an extra $298.2 million over four years from 2016‑17 towards a number of measures aimed at reducing the impacts associated with ice and other drugs to individuals, families and communities. This funding will strengthen responses across education, prevention, treatment, support and community engagement.
A number of these measures focus on empowering local communities, including those within regional areas, with the establishment of a new online portal of information for parents, teachers and community organisations, the implementation of Local Drug Action Teams to bring together community groups to reduce drug related harms, with a focus on ice, and support for community sporting clubs to deliver prevention messages about ice with a focus on rural, regional, remote and Indigenous communities.
This additional investment also includes $241.5 million for Primary Health Networks (PHNs) to commission more alcohol and other drug treatment services, with a focus on ice, including $78.6 million for Indigenous specific services, based on what is necessary and appropriate to the needs of their local communities. PHNs are well placed to fund local services according to agreed evidence and based on population planning, to ensure the coordination of services across the continuum of care.
Home Medicines Review Program
The Home Medicines Review Program aims to improve the quality use of medicine by a patient and reduce the risk of medication misadventure. Patients receive in-home reviews of their medication by an accredited pharmacist, following referral from their general practitioner.
The program also includes a Rural Loading Allowance to provide support to pharmacists to enable patients in rural and remote locations to access this program. This allowance is up to $125 (excluding GST), to contribute towards travel costs incurred by pharmacists to conduct the interview in a patient’s home.
Northern Territory Remote Aboriginal investment—Health component
The health component of the National Partnership on Northern Territory Remote Aboriginal Investment is providing $26.4 million over four years from 2017‑18 to reduce the incidence and severity of ear and oral disease in Aboriginal children in the Northern Territory, with a focus on remote areas. The Northern Territory Remote Aboriginal Investment commenced in 2015‑16, continuing the ten-year commitment to this activity which commenced in 2012‑13 under the National Partnership on Stronger Futures in the Northern Territory.
Indigenous Australians’ Health Programme
The Government is providing $3.8 billion over four years from 2018‑19 to the Indigenous Australians’ Health Programme. Through this program, Aboriginal and Torres Strait Islander people have access to effective health care services in areas of need (including medical outreach to rural and remote areas), targeted initiatives to improve prevention and primary health care management of chronic diseases, and maternal and child health activities. In 2018‑19, continued implementation of the Aboriginal and Torres Strait Islander Health Plan will ensure that regional investments are made in priority areas in consultation with the Indigenous health sector.
Prioritising Mental Health—Improving Telehealth for Psychological Services in Regional, Rural and Remote Australia
The Government will provide $9.1 million over four years from 2017‑18 to remove barriers to telehealth through enabling better access to psychological services in rural and regional Australia via a range of telehealth delivery channels. This measure will increase access to psychological services for those living in rural and remote areas who would otherwise have limited access to those services. Access via telehealth will allow appropriate health professionals to connect with patients sooner than otherwise might have been the case, and without the time and expense involved in travelling to major cities or larger regional centres.
Prioritising Mental Health—Suicide Prevention Support Programs
This measure provides $11.1 million over three years from 2017‑18 to help prevent suicide in high risk locations. The Australian Government will work with states and Territories to deliver small infrastructure projects to reduce incidences of suicide and self‑harm at identified hotspot sites in regional and metropolitan locations across Australia.
Headspace—Strengthening Mental Health Care in Australia
The Government is providing an additional $28.9 million over three years from 2017‑18 for an additional 10 headspace centres across Australia by 2019. These additional headspace services will assist to increase access for young people aged 12‑25 years living in regional and remote areas, increasing headspace services from 100 to 110.
Of the 10 new headspace services, two will open in 2017-18, with headspace Grafton (New South Wales) officially opened on 18 December 2017, and headspace Whyalla (South Australia) was officially launched on 19 April 2018. The remaining services are due to be operational by 2019.
A regional trial of headspace services has also been announced for the Pilbara (Western Australia). The Pilbara trial will explore how the headspace model can be applied in more remote location, particularly where there is a dispersed youth population.
Funding will be provided to Primary Health Networks as the commissioners of headspace services to promote integration and regional approaches in the delivery of headspace services for young people.
New Investment in Digital Technologies for Mental Health—Strengthening Mental Health Care in Australia
The Government is providing an additional $32.4 million over three years from 2016‑17 to support a new investment in digital technologies which will support regional access to services. Funding will enable Project Synergy, which has been trialled as an online system of care, to continue as a research and capacity building project. Synergy will trial customised IT-based solutions, and develop the next generation of digital mental health services and apps. Funding will also enable Lifeline Australia to trial a new text service for crisis support and suicide prevention.
Alcohol and Drug Foundation—Good Sports Program
The Government will provide additional funding of $10.0 million over two years from 2018‑19 to the Alcohol and Drug Foundation for the continuation of the Good Sports Program. The program supports community sporting clubs to reduce harmful alcohol consumption through grassroots prevention and health promotion activity. The Good Sports Program will reach more than two million Australians through 10,000 participating sporting clubs, across 70 sporting codes with a focus on clubs in rural and remote Australia.
Project Agreement on Healthcare and Disease Prevention in the Torres Strait Islands—Schedule A: Addressing Blood Borne Viruses and Sexually Transmissible Infections
This agreement provides funding of $4.5 million over four years from 2016‑17 and aims to address rising rates of blood borne viruses and sexually transmissible infections (STI). One of the elements of the Blood Borne Viruses and Sexually Transmissible Infections Prevention Program is the delivery of STI reduction programs targeted towards Aboriginal and Torres Strait Islander priority populations in regional and remote settings. This element of the program aims to increase STI testing and treatment, and raise awareness about STI prevention. Areas of focus include models of care that reach high prevalence communities and young people.
Project Agreement on Healthcare and Disease Prevention in the Torres Strait Islands—Schedule B: Managing Torres Strait / Papua New Guinea Cross Border Health Issues
This agreement provides funding of $19.0 million over four years from 2016‑17 for the management of Torres Strait/Papua New Guinea cross border health issues. Under this agreement, the Australian Government contributes funding to the Queensland Department of Health for the treatment of Papua New Guinea nationals who travel through the Torres Strait Treaty Zone and access health facilities in the Torres Strait and elsewhere within the Queensland Health hospital network.
Project Agreement on Healthcare and Disease Prevention in the Torres Strait Islands—Schedule C: Mosquito Control and Cross Boarder Liaison in the Torres Strait Protected Zone
This agreement provides funding of $3.0 million over three years from 2017‑18 for the Torres Strait Health Protection Strategy—mosquito control and cross border liaison in the Torres Strait Protected Zone. This agreement supports surveillance, control and elimination, if possible, of Aedes albopictus mosquitoes in the Torres Strait, and to prevent the spread and establishment of Aedes albopictus from the Torres Strait to mainland Australia. The agreement also supports the employment of a Torres Strait Communications Officer to coordinate improved data sharing with Papua New Guinea on communicable diseases and health issues arising from cross border movements in the Torres Strait Protected Zone.
National Critical Care and Trauma Response Centre
The Government provides funding of $63.5 million over four years from 2015‑16 to the Northern Territory Government to support its continued operation of the National Critical Care and Trauma Response Centre based in Darwin. The centre is equipped and ready to assist in response to large scale emergencies and disasters in Australia and the region. Beneficiaries of the program include regional Australians, particularly during times of emergency when an event has the potential to overwhelm or exhaust a state’s or territory’s health resources. The location of the centre also supports a positive regional impact by attracting health expertise and infrastructure to the Northern Territory.
Supporting Living Organ Donors—continuation and expansion
The Government is providing funding of $4.1 million over four years from 2017‑18 to ensure that cost is not a barrier to living organ donors to donate.
The Supporting Living Organ Donors Program is a continuation and expansion of the Government’s Supporting Leave for Living Organ Donors Program that ceased on 30 June 2017.
The program now provides:
- financial contribution to employers to either replenish an employee's leave or contribute towards reimbursing an employer who has made a payment to their employee in place of income lost due to organ donation
- funding of up to $1,000 directly to the donor to meet some of the out-of-pocket expenses incurred as a result of the donation.
From 1 July 2017, the program has been expanded to allow donors to claim reimbursement for some out-of-pocket expenses, enabling donors who are not employed to participate. As transplant units are based in major metropolitan hospitals, providing for some out-of-pocket expenses will particularly assist living donors from rural or regional Australia.
Management of Per- and Poly-Fluorinated Alkyl Substances at Defence bases
The Government is providing $14.0 million over four years from 2016‑17 to undertake human health related initiatives to support communities in Williamtown New South Wales (classified as MMM1 and MMM2) and Oakey Queensland (MMM5) affected by Per- and Poly-Fluorinated Alkyl Substance (PFAS) contamination. These initiatives include:
- an epidemiological study that will look at potential causes and patterns of health effects in the Williamtown and Oakey communities
- a Voluntary Blood Testing Programme for those who have lived or worked in the Williamtown and Oakey investigation areas
- additional dedicated mental health and counselling services in affected communities of Williamtown and Oakey
- a communication strategy focusing on human-health related aspects of PFAS contamination.
From 2017‑18, the Government is providing $5.7 million over four years to extend the above initiatives to include Katherine Northern Territory (MMM6) and provide support to the Katherine community affected by PFAS contamination.
Proposed Options for Communities Affected by Per- and Poly-fluoroalkyl Contamination
The Government is providing $12.5 million over four years from 2017‑18 to establish a national research program into the human health effects of prolonged exposure to per- and poly-fluoroalkyl (PFAS) contamination. The program will be administered by the National Health and Medical Research Council, with grant funding to be delivered to researchers through a call for proposals. This funding also includes the establishment and administration of an expert health panel, with one of its roles being identifying priority areas for research.
PFAS contamination is a national issue which impacts both regional and metropolitan areas. This measure will help improve our understanding of the potentials health effects of PFAS exposure, which will support to regional communities that have been impacted by PFAS contamination.
Quality Assurance for Aboriginal and Torres Strait Islander Medical Services Programme
The Government is providing $5.5 million over four years from 2017‑18 to the Quality Assurance for Aboriginal and Torres Strait Islander Medical Services Pathology Program. The program supports the better diagnosis and management of diabetes in Aboriginal and Torres Strait Islander communities by enabling participating health services to provide culturally appropriate and clinically effective point-of-care diabetes related pathology testing. The program also includes training, technical support, quality assurance and a consultation program for community leaders to support program management on site.
As at 18 January 2018, a total of 194 active services were enrolled to participate in the program, with the majority of these located in rural and remote areas. A further 12 sites are anticipated to be enrolled once staffing issues are resolved.
Australian Government Hearing Services Program
The Government is expected to provide around $2.3 billion over four years from 2017‑18 to the Hearing Services Program to provide eligible people with access to a range of high quality hearing services and devices. Eligible clients in regional communities can access these services through two mechanisms:
- the Voucher program uses a national network of approximately 280 contracted service providers, including Australian Hearing, with 118 service providers located at 1,350 regional sites across Australia; and
- Community Service Obligations—Australian Hearing is funded to deliver specialist services from permanent, visiting and remote sites across Australia, to children and young adults up to the age of 26, and to other high risk groups such as eligible Indigenous Australians. Australian Hearing works closely with local services to deliver its Indigenous outreach program providing hearing services to more than 130 of Australia’s most remote communities. In 2016‑17, around 9,500 services were delivered at 238 outreach sites across Australia.
Visiting Optometrists Scheme
The Government is providing funding of $20.7 million over three years from 2017‑18 to provide outreach optometry services for people in rural, regional, and remote areas, who would not otherwise have access to eye health services.
Enhanced Response to the Syphilis Outbreak
The Government is providing $8.8 million over three years from 2017‑18 to progress the enhanced syphilis outbreak response in rural and remote areas. Funding will go towards:
- rapid point of care tests and treatment
- some additional staff and a short-term surge response to support states and territories to get on top of the issue
- assisting the Aboriginal Community Controlled Health Organisations (ACCHO’s) should additional support for the ACCHO’s be required for the Test and Treat response
- development of communication and education materials
- enhanced surveillance.
Developing Northern Australia—Positioning the North as a Leader in Tropical Health
The Northern Australia Tropical Disease Collaborative Research Program is providing $6.0 million, having commenced in January 2017 with an expected completion date of December 2020, to the Menzies School of Health Research to undertake innovative high quality research into the prevention, diagnosis, and treatment of tropical diseases in Northern Australia.
This program strengthens partnerships with research institutions across Australia, by undertaking a research agenda that helps close the gap in Indigenous health disadvantage, protect Northern Australia from emerging infectious threats and engage regional neighbours.
A Northern Australian network is being established that will incorporate Indigenous engagement, mentoring and knowledge translation, and facilitate collaboration with southern partners.
This investment is part of a broader Government strategy to build Australia’s primary research capacity and support the development of Northern Australia as outlined in the White Paper on Developing Northern Australia.
Residential Aged Care Viability Supplement
The Residential Aged Care Viability Supplement is paid to eligible residential providers operating in rural and remote areas. This supplement provides support for the higher operating costs associated with providing care in rural and regional locations.
Aged Care Provider Funding—Improving the Targeting of the Viability Supplement for Regional Aged Care Facilities
The Government is providing an extra $102.3 million over four years from 2016‑17 to increase and better target the viability supplement under the Modified Monash Model. Changes to residential care, home care and flexible care came into effect on 1 January 2017. Approximately 250 mainstream services benefitted from the new arrangements.
Aged Care Provider Funding—Addressing Growth in Residential Aged Care
To address any impacts from the changes to the Aged Care Funding Instrument, the Government announced on 6 December 2016 that eligible rural, remote and homeless service providers eligible under the 2017 scheme will receive an increase to the Viability Supplement. From 1 July 2017, the 2017 scheme of the Viability Supplement was increased by $19.3 million over four years, through a flat rate increase of an additional $2.12 per resident per day.
Multi-Purpose Services Program—Aged Care Subsidies
The Government is providing $745.8 million over four years from 2017‑18. The Multi-Purpose Services Program is a joint initiative of the Australian Government and state and territory governments, and provides integrated health and aged care services for small regional and remote communities. As at 30 June 2017, there were 179 Multi-Purpose Services delivering 3,636 aged care places through this program.