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Rural health ready for reform
Mary Harvey | ASMS Policy Advisor
The big health shake up could have profound effects in rural health care, ASMS Policy Advisor Mary Harvey writes.
A new ASMS Research Brief argues that people in rural areas should expect similar health outcomes to those in urban areas. Written just before Health Minister Andrew Little unveiled a sweeping reform of the sector – whose scope goes far beyond what most people expected – the Research Brief examines the impact of the postcode lottery in rural areas.
People living in rural areas face significant barriers, including long travel distances to access health care. A particular difficulty is recruiting and retaining doctors and other health professionals. The proposed changes include replacing district health boards with one national organisation – Health NZ.
Under the new health system, hospital and specialist services will operate as a network and be managed regionally. There is a promise of greater clarity and consistency on which services rural communities can expect to be able to access, and where they will be delivered.
ASMS welcomes these changes. We also support the decision to establish a fully empowered Ma -ori Health Authority. This development will strengthen the system’s ability to address health inequities for Ma -ori, many of whom live in rural areas and experience poorer access to health services. We note that Health NZ will be charged with developing a New Zealand Health Plan. We expect to see the current difficulties accessing and delivering health care in rural areas to be addressed.
While supportive of the direction of the reforms, ASMS is disappointed at the lack of focus on rural health in the announcement.
In many rural communities, the barriers to access are even higher for specialist services such as mental health, maternal health, and emergency care. Poor access to services is felt more keenly by vulnerable groups, particularly Ma -ori who live in rural areas with high levels of deprivation. ASMS argues that people in rural areas should expect similar health and disability outcomes for their communities as people living in urban areas. We believe the Government has an obligation to support rural hospitals with funding and staffing models to ensure access to safe, high quality health care services.
The development of the Rural Hospital Medicine (RHM) scope of practice in New Zealand is helping to improve recruitment and retention of rural hospital doctors in some areas. There are good examples, such as in the Hokianga, where this workforce and the rural generalism model of care works well. Nevertheless, there is a severe shortage of doctors across rural hospitals and general practices, and a heavy reliance on locums to fill the gaps. The Research Brief notes the high rate of burnout experienced by RHM doctors. In addition, a large proportion of RHM doctors and rural GPs are international medical graduates. Many do not stay in New Zealand for long periods. At the same time, we are aware of a continuing decline in rural GP numbers; the rural general practice workforce is under considerable strain.
ASMS recognises that rural communities are diverse, and have different needs, depending on their location and relative distance to large centres. Approaches to the provision of health care in rural areas must be tailored to local circumstances. However, there is an urgent need for an overall plan for rural health services in New Zealand. Successive governments have tended to overlook the problem of inequitable access to health services for rural populations. We believe the health sector reforms offer a once-in-alifetime opportunity. This will require a strong focus on developing and supporting a sustainable rural medical workforce, and a clear plan for achieving equitable health outcomes for rural populations. The ASMS Research Brief – “Rural health at a crossroads: tailoring local services for diverse communities” – is available on the ASMS website.