Speaking On Healthcare in the bush

I thank the member for Ryan from bringing this matter before the House and congratulate her on her advocacy for this important organisation providing services to people in rural and regional Queensland.



I cannot be as kind to the policies of her government when it comes to providing services to people who live in the bush—but more of that shortly.

I want to touch on some of the problems that are confronting people who are living in rural and regional Australia, particularly the healthcare problems, because the further you get from the capital cities the shorter is the average lifespan. In fact, compared with major cities, life expectancy in all regional areas is one to two years shorter, while in remote areas it is a whopping seven years shorter. People in the bush are more likely to engage in the sorts of behaviours that are associated with poor health. There are higher rates of smoking, for example, and, because of the great distances that need to be travelled between towns, often less physical activity. People living outside of major cities are also more likely to be admitted to hospitals for conditions that could have been prevented through access to non-hospital services and care services such as the primary care services that the member for Ryan spoke about in her contribution.

When you look at the incidence of chronic disease in regional and remote areas, females are 1.3 times—that is, 30 per cent—more likely to be reporting suffering from diabetes. The prevalence of asthma in inner regional areas is significantly higher than in major cities. Males in regional and remote areas are 1.4 times more likely and females just as likely to be reporting dangerous levels of bronchitis than those who are living in major cities. In regional and remote areas, males and females are 1.3 and 1.2 times, respectively, more likely to be reporting suffering from arthritis than people within capital cities. When it comes to cancer, compared with major cities the incidence of cancer is significantly higher in all regional areas. Melanoma is responsible for the large proportion of the excess new cases of cancer in regional areas. Its prevalence is 60 per cent greater, in fact, followed by colorectal cancer at 16 per cent, lip cancers at 15 per cent and lung cancers at 12 per cent. So there is a gap.

If we go to the area of mental health, we can see we have a significant problem in regional and rural Australia as well. Males in outer regional and remote areas are significantly more likely, 1.2 times more likely, to show high to very high levels of psychological distress when compared to their counterparts living in the major cities. Nationally, in 2012 over 2½ thousand people died from suicide, almost double the national road toll. Tragically, the suicide rate is 66 per cent higher in regional areas than in our cities.

When you look at dental care and children, six-year-old children in some remote areas have much higher rates—between 30 and 60 per cent higher rates—of decayed, missing or filled teeth than their counterparts in areas with much higher access to dental care. Twelve-year-old children in moderately accessible areas and very remote areas also tend to have more decayed, missing or filled teeth than their counterparts in highly accessible areas—in this instance, between 20 and 30 per cent higher rates.

Madam Deputy Speaker Price, against this backdrop—this whopping gap between health outcomes in areas such as your own and in areas such as parts of my electorate and health outcomes enjoyed by people in metropolitan cities—you wonder: why would any sane government introduce policies which were designed to make it harder for people to access their health professionals, particularly in the primary care setting? But that is exactly what this government has done in its first 2½ years.

Consider Medicare Locals. We created 61 Medicare Locals when Labor was in government. Their objective was to look at the areas where there were chronic health issues or gaps in health service delivery and to ensure we could put in place the sorts of services that were needed to close those gaps. They put in place the coordination of local services. They undertook independent reviews to ensure that, where new services were put in place, they were doing exactly what they were designed to do. But the former health minister never really understood what Medicare Locals were all about. He promised to abolish them, then he promised not to abolish them and then, after getting into government, he did abolish all of them and replaced them with new Primary Health Networks—about 31 around the country.

Those Primary Health Networks have significant problems. Some of them are far too big. For example, there is one Primary Health Network for the entirety of North Queensland—an area of greater size than the whole of Victoria. One PHN in your state, Deputy Speaker, covers 99 per cent of the state. There are only two PHNs covering the whole of South Australia, and there are significant problems with the design and the borders in a lot of those areas. In Albury-Wodonga, two rival state governments have managed to put in place a single health district spanning both states—and the Medicare Locals that were put in place mimicked that arrangement. The minister did not like it. He split it up and replaced it with two Primary Health Networks. It is opposed by everyone in those areas and it is creating more barriers to delivering and accessing healthcare. It was a folly, a massive waste of time and a massive waste of resources—again making it harder for people in rural and regional Australia to access the services they need.

Next I point to hospital cuts. The Liberal-National government ripped more than $57 billion in funding from public hospitals. They axed the national funding agreement with the states. State premiers of whatever political flavour are now warning that these cuts are unsustainable—leading to the closure of beds and putting many rural and regional hospitals, and hospital based services, at risk.

Then of course we have the GP tax and the GP tax by stealth—by which I mean the rebate freeze. They are hell-bent—these are harsh words towards your government, Madam Deputy Speaker—on destroying the Medicare system and, importantly, the GP practices that are the mainstay of healthcare provision within rural and regional Australia. The Medicare rebate freeze has been described by the Australia Medical Association as likely to see less bulk-billing and the possibility of a co-payment by stealth. It is going to drive the costs of medical services up in rural and regional Australia—once again making it harder for those people who most need those services to find access to them. I could add to this the $800 million that has been cut from the Health Flexible Funds. Importantly, these funds are funding regional health programs and remote health programs, along with a range of other services, including Aboriginal and Torres Strait Islander health services.

Against the backdrop of all of these cuts, I welcome the fact that the member for Ryan has put the issue of bush kids on the parliamentary agenda, but I have to be harshly critical of the policies of her government for what they are doing in attacking healthcare services in the bush for people of all ages. We understand the critical importance of allied health services for people in the bush. It is sometimes very difficult, for love or money, to get an audiologist, a dietician, a psychologist or occupational health services in a remote area, because there is not much of a private market for those services—I would add to that physiotherapy services in remote Australia. The role of the hospital based services, the role of the Primary Health Networks and the role of those services funded by the Health Flexible Funds are absolutely critical.

I use the opportunity of this parliamentary debate, which goes to rural and regional healthcare provision, to again challenge the minister. I have done this on several occasions.

I ask you to guarantee that not one dollar of the $800 million worth of cuts to the Health Flexible Funds will fall upon those services that are currently being provided to rural and regional Australia. That would be a good outcome.