The urgent need for equity in patient assistance travel schemes

Abstract

Access to health care is a fundamental right for all Australians. Yet, for many living in rural communities, this right is often compromised by geographical and financial barriers, creating a health care landscape marked with inequity. While the Patient Assistance Travel Schemes (PATS) were designed to ease the burden of travelling for medical care, the reality is that these programs fall woefully short, exposing critical disparities that undermine their health.

The intention behind PATS is commendable. These schemes aim to alleviate some of the financial burdens faced by individuals who must travel long distances to receive the care they are not able to access in their region, or specialised medical care. However, the execution reveals a troubling gap between intent and reality. Current subsidies do not reflect the true financial and emotional strain that rural patients and their families incur. While patients may be able to claim partial reimbursements towards travel and accommodation, additional costs such as meals, time away from family and lost income during treatment are not covered.¹ These out-of-pocket expenses can create a significant financial burden. The notion that individuals must choose between paying bills and accessing health care is unacceptable and inequitable.

Adding to the frustration is the lack of meaningful increases in reimbursement rates over the past decade. In Victoria, the private vehicle reimbursement rate has barely budged from 20 to 21 cents per kilometre, while the support for commercial accommodation has only increased from $45.10² to $49.50 per night (including GST), when actual accommodation costs are near $250 a night and parking is up to $60 a day. These minimal adjustments do not keep pace with the rising cost of living, fuel, parking and accommodation. As inflation continues to impact everyday expenses, the inadequacy of PATS reimbursement become increasingly glaring.

Compounding these issues are the inconsistencies in subsidy levels across different states and territories. While some jurisdictions, such as Tasmania, offer more support,³ others, such as Western Australia, provide minimal assistance.⁴ This patchwork approach creates inequities that disproportionately affect rural populations, including Aboriginal and Torres Strait Islander communities, who face additional barriers to accessing care.⁵

The bureaucratic hurdles involved in claiming travel assistance add yet another layer of complexity. In Victoria, patients often endure long wait times—sometimes several weeks—while navigating a predominately paper-based submission process.⁶ In contrast, New South Wales typically processes claims within 2 weeks through an online portal.⁷ These discrepancies lead to unnecessary delays for patients who are already grappling with the stress of medical travel, hindering timely access to care⁸ or not accessing care at all.

Health literacy also plays a critical role in navigating the health care system. Studies indicate that individuals in rural areas often have lower levels of health literacy than their urban counterparts, impacting their understanding of PATS eligibility and the reimbursement process.⁹ This disadvantage is particularly acute for older populations or those with limited internet access, leading to missed opportunities for vital support.

Eligibility criteria for PATS present another pressing issue, varying dramatically from one jurisdiction to another. In New South Wales, for example, patients must travel more than 100 kilometres to qualify for assistance.⁷ In contrast, in Victoria, even a trip of 50 kilometres might be eligible.⁶ This inconsistency breeds confusion and can deter individuals from seeking necessary care. When patients are uncertain whether they qualify for assistance, they may forgo critical medical appointments, putting their health at further risk.

Moreover, the distance threshold across states and territories ranges widely, from 50 kilometres in Queensland and Victoria,^{1, 2} to 200 kilometres in the Northern Territory.¹⁰ This lack of uniformity not only complicates the application process but also leads to inequalities in access to care. Patients should not have to worry about navigating a convoluted system that varies dramatically depending on their location; health care access should be a right, not a privilege determined by geography.

What is abundantly clear is that a national framework for PATS is essential to address these equity issues. While standardising eligibility criteria and funding levels would help ensure that all Australians, regardless of their location, have equitable access to support they need, it is equally important to factor in the unique differences between jurisdictions. For instance, larger geographic areas may require additional considerations to effectively meet the needs of their populations. By prioritising uniformity while allowing for these variances, we can mitigate the disparities that currently exist, fostering better health outcomes for rural communities.

Ongoing evaluation and feedback from patients should inform any reforms. Engaging communities to understand their unique challenges and needs will help ensure that PATS are responsive and effective.

Considering the current underservice and underspend on health care in rural communities, and the fact that rural people are dying 12–16 years earlier than their urban counterparts, we need to ensure that there is equitable access for all rural people.

Recognising the need for clearer information, the National Rural Health Alliance has recently updated its PATS fact sheet, which is now available on our website. This resource aims to provide essential guidance for patients navigating these schemes, helping demystify the process and ensure that individuals are aware of their rights and entitlements.

As we work towards a more equitable health care system, we must confront the geographic inequalities that exist within it. PATS are vital in addressing these disparities, as they acknowledge that not all health services can be found in every location.

Rural Australians, in particular, face significant barriers to accessing necessary health care, often leading to poorer health outcomes. PATS are designed to address this inequality by providing the financial support to assist travel for care, but the current structures across the jurisdictions is woefully inadequate.