Fair Funding for Rural Health, an Urgent Call

Abstract

The Albanese Government now has the opportunity to swiftly advance the numerous reviews and recommendations to ensure health equity for all Australians. The reviews developed in collaboration with stakeholders, including the National Rural Health Alliance (the Alliance) during their first term, recommended innovative solutions, which will go a considerable way in supporting rural, remote and regional communities, as well as urban centres. The government must now ensure that it implements grassroots recommendations, as it is there that flexible implementation and funding are needed the most. The Alliance is standing by to work hand in hand with the government to ensure that no one continues to be left behind.

The Alliance has worked closely with the first-term government on the Unleashing the Potential of our Health Workforce: Scope of Practice Review, the Strengthening Medicare Measures, the National Medical Workforce Strategy, and the Australian Digital Health Workforce Strategy. With solutions at hand, the newly elected government is now tasked with taking this a step further by putting words into practice and funding in place. Rural, regional, and remote communities rely heavily on the government's policy, funding, and flexibility to achieve health equity.

The Alliance, through its work with its members, communities and other stakeholders, considers every day how we can ensure that workable solutions are provided to the government. We need to ensure that expenditure in healthcare delivery, research, workforce training and education, as well as infrastructure and systems that underpin the health and wellbeing of rural Australians, is equitable.

The fact that rural populations are sicker than urban individuals is not new. Rather, it is getting worse with remote men dying up to 13.6 years and rural women 12.7 years earlier than in urban Australia.

It remains disappointing and unacceptable for a Western country to treat 30% of the population that provides for Australia's economic wellbeing as a burden, rather than a population that is valued, important and treated equitably. The first-term government's reforms promise to break down these barriers and inequities, and the Alliance eagerly awaits to see positive results.

The solutions are also in the context of the annual $6.55 billion health underspend in rural Australia compared to city expenditure. It is also important to factor in Australia's reliance on rural Australia for its economic contribution and vibrant and positive lifestyle status, despite the high cost of living and climate challenges such as drought, flooding and other extreme weather events.

The Alliance has been working with the Department of Health and Aged Care to provide positive solutions, rather than tweak policies around the edges. Medicare, while very much valued, is but one tool. Equitable access requires more than Medicare. The investment of $8.5 billion to strengthen Medicare, which includes funding for an additional 18 million bulk-billed general practitioner (GP) visits per year, nursing scholarships, and increased GP training opportunities, is a great commitment to rural communities. However, the government must address the challenges faced by rural and remote GP or primary care practices that cannot afford to bulk bill services for communities. This is due to the cost of delivery and structural challenges. Bulk billing does not allow what works in the city to be implemented in the country.

The Alliance welcomes the positive changes in Budget 2025–26 to building the primary care workforce and the Medicare bulk billing incentive. However, we are concerned that the Budget has focused on health measures where metropolitan and outer urban areas will mainly be the key beneficiaries.

Training the future primary care workforce, Close the Gap Indigenous health initiatives that increase the availability of culturally safe and qualified mental health support, as well as building the First Nation's health and medical workforce, and housing and infrastructure are very much needed, and are a great commitment to Indigenous communities.

The availability of more university medical places focused on primary health care, and the previously announced 100 Commonwealth Supported Medical Training Places from 2026 increasing to 150 per year by 2028, are positive, especially if they are for rural Australia. Indeed, the rural training of any health specialty is a priority, as well as ensuring that we increase the Indigenous health and medical workforce, whether via primary school awareness initiatives, University places or scholarships.

The government's commitment to establish another 50 Medicare Urgent Care Clinics (UCC) is valuable and will generally benefit the cities. Thirty-four of these will be located in MM1, followed by six in MM2, then seven in MM3. There are no UCCs in MM6 or MM7 among these additional 50 UCCs.

New South Wales (14 clinics): Bathurst, Bega, Burwood, Chatswood, Dee Why, Green Valley and surrounds, Maitland, Marrickville, Nowra, Rouse Hill, Shellharbour, Terrigal, Tweed Valley, Windsor

[11 × MM1; 0 MM2; 2 × MM3; 0 × MM4; 1 × MM5; 0 MM6; and 0 MM7]

Victoria (12 clinics): Bayside, Clifton Hill, Coburg, Diamond Creek and surrounds, Lilydale, Pakenham, Somerville, Stonnington, Sunshine, Torquay, Warrnambool, Warragul

[9 × MM1; 1 × MM2; 1 × MM3; 1 × MM4; 0 MM5; 0 MM6; and 0 MM7]

Queensland (10 clinics): Brisbane, Buderim, Burpengary, Cairns, Caloundra, Capalaba, Carindale, Gladstone, Greenslopes and surrounds, Mackay

[7 × MM1; 2 × MM2; 0 MM3; 0 MM4; 1 × MM5; 0 MM6; and 0 MM7]

Western Australia (six clinics): Bateman, Ellenbrook, Geraldton, Mirrabooka, Mundaring, Yanchep

[4 × MM1; 1 × MM2; 1 × MM3; 0 MM4; 0 MM5; 0 MM6; and 0 MM7]

South Australia (three clinics): East Adelaide, Victor Harbour, Whyalla

[1 × MM1; 0 MM2; 2 × MM3; 0 MM4; 0 MM5; 0 MM6; and 0 MM7]

Tasmania (three clinics): Burnie, Kingston, Sorell

[0 × MM1; 2 × MM2; 1 × MM3; 0 MM4; 0 MM5; 0 MM6; and 0 MM7]

Northern Territory (1 clinic): Darwin [1 × MM2]

Australian Capital Territory (1 clinic): Woden Valley [1 × MM1]

It is of note that this pattern of allocation towards more urban and outer urban areas and less in rural and remote areas in all states and territories is not dissimilar to that of the existing 87 UCCs, with locations skewed in favour of MM1 (55). In this cohort, the number of UCCs in MM7 (6) is disproportionately higher compared to MM4 (1), MM5 (2) and MM6 (2) combined, due to these six UCCs being located in the Northern Territory.

These announcements might demonstrate a need and could support the long emergency department waitlists. However, the utterly metropolitan-centric thinking in policy still does not address the workforce shortage. It is important to look after the local health and medical workforce, the infrastructure, and access and scale issues faced by many, as there is no market, or it is thin. We need to ensure that our rural GPs, nurses, allied health, psychologists, and other practitioners and clinicians are supported as we cannot afford more to burn out, churn or leave and resort to 6-min medicine/health. This is not the kind of medicine needed in our rural communities.

Support for education and training scholarships targeting nursing and medical students, including expanding the Primary Care Nursing and Midwifery Scholarship Program, and extending the Obstetrics and Gynaecology Education and Training Program, is welcome. However, these are not specific to rural Australia. The Budget also expands the Australian General Practice Training Program and the Remote Vocational Training Scheme to deliver 200 new general practitioner training places each year from 2026. We hope that the delivery of these scholarships will increase the limited workforce in rural Australia. It sends a message to those who will consider a rural career, SA Clinical Prioritisation Criteria (CPC) for adult and paediatric services, that it is a great career and lifestyle.

The elephant in the room is that we need to address the structural, legislative and policy levers that are currently in place. We have all been working on these in various ways to improve health care in rural, remote and regional Australia. We look forward to working on this with the government.

Feedback from rural general practices has indicated that for a large proportion of GPs who are now having to charge private fees to keep their doors open, the proposed bulk billing change will potentially be a 30% cut in their revenue. In many cases, this exacerbates their current financial loss, which is often topped up by community fundraising and larger rates charges by local governments to keep the clinics viable. It is unreasonable to expect these practices to continue serving their population out of goodwill to meet the health needs of their communities. It is unreasonable that many rural communities around Australia need to carry out additional fundraising activities to ensure their services remain viable and do not close. We cannot imagine this occurring in a suburb of a major city.

To fund the care these community-based practices provide, many will have to remain with blended models of payments (mostly private billing but with some bulk billing to service priority population groups) including block funding. This will be to cover the discrepancies of these market conditions and to meet the needs of communities, even allowing for incentives. Many, often in MMM 4, 5, 6, have noted that with the loss they make year on year, even with the blended model, there would be no room for growth and innovation, staff professional development support and even less money to pursue preventive health programmes in the community. The cost of a local workforce and service delivery is high. This cannot be compared to an urban centre. Yet, it is still less than relying only on locums and fly-in-fly-out services.

GPs are seeking greater support for mental health consults to help deal with the complexity and comorbidities they face every day in their clinics—the kind of care that keeps people out of hospitals. This announcement does not address this at all at this stage, nor does it address multidisciplinary care which is critical and needs to be supported in rural and remote areas. It does not address the negative balance in the profit and loss statements for a large section of rural primary care providers, which also includes psychologists and other health practitioners. We have urged the newly elected government to take stock of what is happening in rural communities and put forward some funding injections and policy changes to give people the care they require, in a way that can be delivered.

The Alliance is looking for parity with urban access to healthcare. We do need a National Rural Health Strategy that coordinates Commonwealth, State, and Territory investment in health, disability and aged care service delivery for rural Australia. It makes sense to do so, and such a strategy would ensure that funding, policy and initiatives specific to rural communities would sit under a coordinated plan of action with its own discrete funding for agreed priority areas.

The Strategy would focus on improving social determinants that affect health outcomes in rural communities, such as educational opportunities and outcomes, access to safe, affordable, healthy housing, and early childhood experiences that promote optimal development. Implementation of the Strategy would demonstrate whole-of-government and state/territory commitment to further health reform and would not only close the gap for Aboriginal and Torres Strait Islander peoples living in rural Australia, but also ensure better health equity and access for all Australians. It makes sense to demonstrate to rural Australia that some policies and initiatives already assist them, and others will be implemented to address the additional needs.

The Alliance remains disappointed that there has been little appetite for a comprehensive National Rural Health Strategy over many years. However, it remains eager and positive to work with the new government, the Cabinet, the Department of Health, Disability and Ageing, communities and other stakeholders to ensure we develop sustainable and equitable solutions. We are pleased that all three areas of disability, aged care and health are under one Minister, as in rural Australia, they naturally work together and support each other.

The Alliance also continues to call for the establishment of a National Rural Health Fund under this strategy. This would support block and infrastructure funding that includes but is not limited to health facilities, housing and childcare, tailored to rural clinician and health student needs to ensure they are supported.

Additionally, the MRFF has worked towards equitable access to research funding and research led by the grassroots. They have made considerable progress to ensure that the inequity of funding going to rural Australians and researchers is addressed. The MRFF provides funding to support projects that address the specific health and healthcare needs that are a priority for people in rural communities. Flexible funding for grassroots-led research is crucial for Indigenous and non-Indigenous communities, as this is where transferable innovative solutions to health, training and service problems are solved, ideas developed, and implementation put in place.

To date, this has included multiple streams of funding for rural research topics and promoting rural research led by organisations and researchers who reside in rural areas. Eligibility requirements for these streams have been based on the MMM model.

Rural research, evaluation and translation are a part of the Alliance's plan to ensure that what is learnt is shared. An Innovation Hub with AI and synthesis capacity, where communities, researchers and stakeholders can share what is occurring in their rural communities, learn, adapt and adopt from others in government and philanthropic-funded research, grants, delivery, and training. This includes linkage with our Australian Journal of Rural Health, which is a crucial vehicle of information from around rural Australia.

Without rural research that addresses the unique challenges and needs of rural communities, including Indigenous communities, we cannot inform policies, practices and funding which ultimately contribute to better health outcomes and stronger communities—indeed a more vibrant and productive Australia.