Evaluation of the Medical Specialist Outreach Assistance Program and the Visiting Optometrists Scheme

Appendix D: Selected government programs targeted at improving access for health services for rural and remote populations

Page last updated: 28 February 2012

Rural Primary Health Services Program

The Rural Primary Health Services (RPHS) program aims to improve access to a range of primary and allied health care services and activities for rural and remote communities. The RPHS program gives community-based primary health care services greater flexibility in the range of services they can offer, including health promotion and preventative health activities.
The RPHS program brings together four former programs:
    • More Allied Health Services (MAHS)
    • Regional Health Services (RHS)
    • Multipurpose Centre (MPC)
    • Building Healthy Communities in Remote Australia.
Guidelines for the MAHS and RHS components of the program are targeted at primary health care services that encompass active treatment, screening programs, health education on individual health risks, and more broadly, efforts to address health concerns for the entire community through preventative health activities. The objectives of these two components are to:
    • Provide and maintain access to supplementary allied health and primary care services that are based on identified health needs in each community.
    • Promote coordinated, multi-disciplinary team based approaches to the provision of integrated primary health care services.
    • Establish and maintain effective community consultation practices for the planning, management, flexible delivery and ongoing review of the RPHS program.
    • Provide and maintain access to relevant health promotion and preventative health programs and activities designed to promote health and wellbeing.
    • Encourage people in rural and remote Australia to adopt or modify behaviours to better manage their health and wellbeing (DoHA 2009).
Service providers are expected to undertake regular community needs assessments and evaluate their performance to deliver primary health care in a way that best meets the identified needs of rural communities. Service delivery models that they use must be responsive to community needs, use the available workforce, and are practical, acknowledging the individual characteristics (e.g. geography, demography, isolation) of their community. The service must also take into account the aims and objectives of the RPHS program.

The previous MAHS was established in 2001to provide increased access to allied health services in rural communities. The main goals of the program are to meet identified needs in communities for service, provide additional (a net increase in) services and to support integration between GPs and allied health providers to reduce the burden on GPs and allow them to focus on primary care. Funding from the program is to GP divisions, to recruit and employ eligible allied health workers. The services that are provided by the program must be provided free of charge and are ineligible for Medicare payments. Location eligibility is based on a formula that includes rural populations within the catchment area.

Multi-purpose services (joint Commonwealth/state/territory): Multi-purpose services (MPS) are integrated services that provide health and aged care services in rural and remote communities. Australian Government funding for aged services is combined with state/territory funding for health and infrastructure to create MPSs that offer multiple types of services within one management system. The benefits of the MPS model are that in communities that do not have the resources to support independent facilities, a broader range of services can be provided in an integrated and cost-efficient manner. As of 1 July 2010, there were a total of 129 MPSs operating across Australia, with several more in development (DoHA 2010c). The intent of a MPS is to address specific problems faced by rural and remote communities, specifically, declining and changing populations, isolation, insignificant demand to support multiple services and challenges in attaining, training and retaining staff. MPSs are able to overcome these problems through improving the range and delivery of health and aged care services, community involvement in health and aged services, increased quality of care, cost-effectiveness and long-term viability of these services.

Section 100 Pharmacy Support Allowance Program (Commonwealth)

Designed to ensure access to specific PBS drugs for people living in isolated areas or who receive medical treatment in circumstances where the PBS benefits cannot be conveniently or efficiently supplied. The Remote Area Aboriginal and Torres Strait Health Services Program allows for eligible clients at Aboriginal and Torres Strait health services to receive medication at the time of service, without a printed prescription and without charge.

Health and Hospital Funds - Regional Cancer Centres (Commonwealth)

Funding designed to supplement state and territory effort through investing in health infrastructure and making strategic investments in the health system. Through Regional Cancer Centres, funding set aside to establish a network of best practice regional cancer centres and accommodation facilities to increase access and support in rural and regional locations.

National Rural and Remote Health Infrastructure Program (Commonwealth)

Under the program, funding is provided in ASGC 2 to 5 communities (up to 20,000 people) for capital works and equipment or for strategic planning for small rural private hospitals. Is administered through a competitive grants process.

National Rural and Remote Health Stakeholder Support Scheme (Commonwealth)

Combines funding for the six peak rural and remote health stakeholder organisations to enable them to contribute to create better policy and programs for rural and remote health issues.

Medical Practitioners Program (Commonwealth)

The program provides higher financial benefits for patients of non-vocationally recognised (non-VR) medical practitioners in rural and remote areas and incentives to encourage non-VR medical practitioners, from Australia and overseas, to provide GP services in rural and remote locations.

Rural Health Workforce Strategy (Commonwealth)

Under the strategy Scaling Incentives encourages doctors to practices in more remote communities. In addition, the HECS Reimbursement Scheme reimburses HECS for doctors who pursue a career in rural medicine to increase the number of doctors practicing in rural and remote locations.

Rural Locum and Procedural programs (Commonwealth)

Top of pageThese include: the Specialist Obstetrician Locum Scheme which increases the locum support for the rural obstetric workforce to improve obstetric care for rural women, the GP Anaesthetists Locum Scheme, which provides subsidised locum support for professional development or a break from on-call commitments, and the Rural Procedural Grants Program through which grants are provided for procedural GPs in rural and remote areas to attend training, upskilling and skills maintenance activities.

Rural Women’s GP Services (RWGPS) (Commonwealth)

RWGPS funds the travel of female GPs to rural communities in all states and the Northern Territory. The program is contracted through the Royal Flying Doctor Service (RFDS). The aim of the program is to provide GP services for women where there is not a female GP available, as some women prefer to see a female GP to discuss personal health matters. Communities have to apply through the RFDS and meet the requirements that their community/cluster of communities is at least 1,000 people, have reasonable access to a male GP and have no female GP within 50km. Typically the service will visit a location between once a month and once every six months.

Indigenous Chronic Disease Package - Primary Care (Commonwealth)

The Increasing Specialist Follow-up Care Measure and Care Coordination and Supplementary Services (CCSS) Program provides care coordination for eligible Aboriginal and Torres Strait Islander patients with a chronic disease, and provides a funding pool to assist patients in accessing specialist and allied health services in accordance with their care plan.

Maternity Services Reform Package (Commonwealth)

In addition to the MSOAP expansion (see above), this package aims to provide more access to midwives through increased MBS and PBS benefits and indemnity insurance for midwives, provide additional training and support for GPs and midwives to expand maternity workforce, particularly in rural and remote areas and expand and improve the National Pregnancy Telephone Counselling Helpline.

Mental Health Services in Rural and Remote Areas (Commonwealth)

The Mental Health Services in Rural and Remote Areas Program is designed to provide better access to mental health services in rural and remote communities. The program is part of the Australian Governments component of the COAG National Action Plan on Mental Health 2006-2011 and is run by DoHA. The program is meant to work alongside the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (MBS) initiative to fund additional services where Medicare funded services are not as readily available. Funds are provided in a flexible manner to organisations such as GP divisions, the RFDS and AMSs to provide mental health services. The service in each location caters to local needs and is designed to be set up in areas of high need for the service.

Mental Health Support for Drought Affected Communities (Commonwealth)

The Mental Health Support for Drought Affected Communities initiative is designed to increase the capacity available to respond to mental health issues in remote and rural communities that are affected by drought. Most of the funding for the program is provided to eligible GP divisions (41 in total) to provide services to the community that include crisis counselling and community outreach. Other services are being provided in eligible divisions for community awareness activities and education and training for health workers through beyondblue and the Australian General Practice Network.

Remote Service Delivery for Indigenous Australians

Under the Closing the Gap in the Northern Territory National Partnership Agreement, funding is provided for follow-up ear, nose and throat (ENT) and dental services to Indigenous children under the age of 16 years with outstanding referrals from a child health check. In 2010-11, 329 ENT consultations and 35 occasions of ENT surgery will be funded under the Agreement.

Royal Flying Doctor Services (RFDS) (joint Commonwealth/state/territory)

The RFDS has been funded by the Australian Government for over 75 years. It also receives funding from some state and territory governments. The RFDS provides aero-medical transport and health services to people who live, work or travel in remote regions of Australia. The main services of the RFDS are: 24 hour emergency service for serious or critical illness or injury outside of the normal medical infrastructure, provision of primary and community health care clinics at remote sites and the provision of medical chests to isolated locations. The Australian Government funds the recurrent and capital costs of the RFDS. State and territory governments fund the transfer of patients between hospitals.

Telemedicine (Commonwealth/state/territory)

States and territories have implemented a range of telemedicine arrangements. These arrangements include the establishment of infrastructure that can be used by private practitioners as well as hospital/health service employees. There is not clear view of the extent of current telemedicine arrangements across Australia.

Telemedicine items have been included in the MBS for psychiatry from around 2000. In the 2011-12 budget, the Commonwealth government announced a major extension to telemedicine under MBS. From July 2011, Medicare rebates for online consultations across a range of medical specialties will be available. Telehealth facilities located in GPs, aged care facilities, AMSs and certain other, non-medical facilities, will be able to videolink patients in rural, remote and outer metropolitan areas with specialists in cities or major regional centres. The patient may be accompanied by their GP or a nurse practitioner, midwife, Aboriginal health worker or practice nurse. The telehealth includes:
    • Financial incentives for specialists, GPs and other health professionals to participate in delivering online services.
    • $50 million to expand the GP after hours helpline and include the capacity for the helpline to provide online triage and basic medical advice via videoconferencing.
    • Training and supervision for health professionals using online technologies.
Participating health practitioners around the country will receive Medicare rebates for their time invested in the consultation, and some support for the technology required. These include increased Medicare rebates for Telehealth, payments to cover start-up costs of installing the technology, and bulk billing incentives. Payments are applicable for both the specialist and the GP, nurse, midwife or Aboriginal health worker assisting the patient during the consultation. The Government aims to have 495,000 Telehealth consultations delivered by July 2015.

A range of telemedicine services have also been supported under MSOAP. The new arrangements will not include services such as Tele-Derm, where a request for assistance occurs via email.

New Medicare items will allow a range of existing consultation services to be provided via video conferencing and additional rebates on top of these items recognise the increased complexity of providing a service to a remote patient. There will be a 50% additional rebate for the specialist service and a 35% additional rebate for the service provided by the practitioner at the patient end.

A financial incentive is being provided to encourage all health professionals to incorporate telehealth services into their day to day practice by including a $6,000 incentive when a health practitioner provides their first consultation.

Bulk billing is encouraged with extra telehealth bulk billing incentives to be paid at a rate of $20 each time a practitioner bulk bills a service in the first year.

State/territory based aeromedical services (state/territory)

States and territories are involved in support or provision of aeromedical services in addition to the RFDS.

State/territory based outreach programs (state/territory)

States and territories have established a range of outreach services. Many of these arrangements are established and negotiated by local hospitals. Many of these arrangements are very long standing, and involve public hospital based clinical teams that have been servicing specific communities over many years.

Patient Assisted Travel Schemes (state/territory)

One of the principal ways in which states and territories assist access is through patient assisted travel schemes (PATS) which go by various names in the different jurisdictions. The first program in Australia to fund patient travel to health care was in 1978 and was managed by the Australian Government, called the Isolated Patient Travel and Accommodation Assistance Program (IPTAAP). From 1987, this program was transferred to state and territory control.

Each state and territory currently operates its own program to assist patients in travel to medical services. The programs in each state and territory are similar, but the specific payment levels and eligibility requirements vary. The first requirement is that the patient must be going for an approved type of care; some specialist visits are covered, whereas others are not. Typically, there are also requirements around having a proper referral from a doctor or sometimes another health care professional. Some states also make accommodations for bulk reimbursement for people with conditions that require regular visits to a specialist, such as for cancer treatment, to make applying for funds simpler. The availability of local services is also a factor in determining eligibility. The closest available service must be a minimum distance from the patient for funding to be provided. Payment levels for travel programs also vary by state and level of need.

Private health insurance policies can also include patient travel assistance, which can be used to cover the cost of visiting a health care provider.

Several important criticisms have been raised about these programs, including lack of uniformity, levels of reimbursement, and challenges to accessing funds. The lack of uniformity in programs means that access to care is not equal for all Australians; depending on where you live, you may or may not receive funds or they may be insufficient to cover expenses. The levels of reimbursement also do not reflect current costs of travel and accommodation.

Other patient transport schemes (state/territory)

Health services and public hospital services provide a range of patient transport arrangements to patients requiring support to attend consultations and hospital services. These services may be operated through the hospital itself, a non-government organisation or in conjunction with an ambulance service. Arrangements vary considerably across health services and communities.

Another program that helps patients get access to care is the Home and Community Care (HACC) Program, which is a joint Commonwealth, state and territory initiative to assist frail elderly Australians and those with disabilities. Independent, not-for-profit organisations also provide transport to patients, though availability varies by location.Top of page