Home page iconHOME |   Contents page iconCONTENTS |   Search iconSEARCH |  Previous Years  PREVIOUS YEARS |

 | TOC | next page


Table of contents

You may download this section of the document in PDF format:

PDF printable version of Outcome 6 – Rural Health (PDF 166 KB)


Outcome Summary

Outcome 6 aims to improve health outcomes for people living in regional, rural and remote communities. The Department worked to achieve this outcome by managing initiatives under the programs outlined below.

Program Administered Under Outcome 61 (Program Objectives in 2008–09)

Program 6.1 – Rural Health Services

  • Fund a range of services in rural and remote areas, including specialist, allied and community health services.
  • Support emergency evacuations and privately insurable health services.
  • Provide coordination grants for small community health care services, and prevention and promotion activities in remote communities.
This chapter reports on the major activities undertaken by the Department during the year, addressing each of the key strategic directions and performance indicators published in the Outcome 6 chapters of the 2008–09 Health and Ageing Portfolio Budget Statements and 2008–09 Health and Ageing Portfolio Additional Estimates Statements. It also includes a table summarising the estimated and actual expenditure for this outcome.

The Primary and Ambulatory Care Division was responsible for Outcome 6 in 2008–09. The Department’s State and Territory Offices and other program areas across the Department also contributed to improved rural health outcomes.

Major Achievements for the Outcome:

  • Established the Office of Rural Health on 1 July 2008 to bring together rural health policy, service delivery, and health workforce distribution, and improve rural health services (see Establishment of the Office of Rural Health); and
  • Helped improve health infrastructure in rural and remote communities, by funding 97 projects for capital works and equipment (see Improving Health Infrastructure in Rural and Remote Communities).

A Challenge for the Outcome:

  • Difficulty in recruiting and retaining appropriately qualified health professionals to deliver health services in rural and remote communities (see Improving Access to Health and Specialist Medical Services).
Top of page

Key Strategic Directions for 2008–09 – Major Activities

Establishment of the Office of Rural Health

An audit of the health workforce in rural and regional Australia, conducted by the Department in 2008, showed that the current supply of health professionals in these areas is not sufficient to meet communities’ needs. In response to the audit, the Department established the Office of Rural Health on 1 July 2008. This major achievement saw key areas from across the organisation with responsibilities for rural health policy, service delivery programs and health workforce distribution, coming together to address this issue.

As a first priority, the office reviewed all targeted Australian Government funded rural health programs, and the geographic classification systems used for determining eligibility for rural program funding. These reviews were necessary to ensure that workforce programs and incentives are based on current population figures and genuine need, and that service delivery programs and rural health professionals more effectively meet the needs of rural communities. Throughout the reviews, the Department consulted with key rural health stakeholder organisations representing medical, nursing and allied health professionals; education and training institutions; rural health service providers; and consumer groups.

The reviews resulted in a rural health reform package announced in the 2009–10 Budget, in which health services will be targeted to priority areas and will include enhancements to specialist, general practice, allied health and primary and community health services. The reviews also resulted in the introduction of the Australian Standard Geographical Classification – Remoteness Areas system which will replace the geographic classification systems previously used to determine eligibility for rural health programs.

The Department will progressively introduce reforms in 2009–10 to ensure that rural health programs are targeted to where funding is most needed, and that workforce incentives and support are based on the underlying principle of ‘the more remote you go, the greater the reward’, to encourage doctors to work in more remote communities.

Funding for the above activities was sourced from Program 6.1 – Rural Health Services. Further discussion on workforce issues can be found in the Outcome 12 Health Workforce Capacity chapter.

Improving Access to Health and Specialist Medical Services

Access to health and medical specialist services may be difficult for people living in rural and remote communities due to factors such as remoteness of location or difficulties in attracting and retaining skilled medical staff. In 2008–09, the Department worked to help improve access, through collaborative efforts with State and Territory Governments, and the management of programs focused on delivering primary health care and specialist services to these areas.
Top of page

Collaboration with State and Territory Governments

In 2008–09, the Department worked with the states and the Northern Territory, through the Australian Health Ministers’ Advisory Council Rural Health Standing Committee, to initiate the development of a new strategic planning approach for rural and remote health that will replace Healthy Horizons: A Framework for Improving the Health of Rural, Regional and Remote Australia. The Department will continue to work with its state and territory counterparts in 2009–10, through intergovernmental forums, to develop the new national strategic planning approach.

The Department also worked closely with states, the Northern Territory and agencies, in consultation with advisory forums in each jurisdiction, to plan and prioritise services supported by the Medical Specialist Outreach Assistance Program (discussed below). The Department will continue to work closely with each jurisdiction during 2009–10 to expand the program under the Council of Australian Governments’ National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes. This will see the introduction of multidisciplinary teams to manage chronic disease in rural and remote Indigenous communities. The Department will also undertake scoping activities to determine where services are needed on a priority basis.

Funding for the above activities was sourced from Program 6.1 – Rural Health Services.

Supporting Integrated Primary Health Care Services

Through the Regional Health Services Program, the Department worked to support community-identified primary health care priorities relating to the prevention and treatment of illness in small rural towns with populations of less than 5,000 people. In 2008–09, the Department provided funding to 118 supplementary primary health care services where it was difficult to attract or retain adequately skilled allied health or primary health care workers. These organisations included state health services, local government, Aboriginal health services, Divisions of General Practice and other non-government organisations that had the capacity to operate effectively in these communities.

While this was good news, obtaining the necessary workforce to deliver services was a challenge due to the isolation of the communities, the difficult physical environment, problems with the availability of infrastructure, and the higher costs of living and working in these areas. In response, the Department provided additional funding to most Regional Health Services where opportunities for service enhancement or expansion were identified.

In addition, the Department funded 43 time-limited primary preventative health and capacity building projects in rural and, especially, remote communities. These projects helped communities to address the key risk factors for chronic disease, or supported the development of a skilled rural health workforce to better respond to health needs. Projects included funding for: the Continence Foundation of Australia to provide support, education and training in continence promotion and care appropriate to Indigenous populations; epilepsy training for rural health professionals via e-learning through Epilepsy Queensland Inc; and a range of similar capacity building projects.

A priority in 2009–10 will be to combine the Regional Health Services with the More Allied Health Services, Multipurpose Centres and Building Healthy Communities programs into the new Rural Primary Health Services Program. This program will eliminate overlap and duplication of effort, and inconsistent program guidelines which were identified by the review of Australian Government funded rural health programs as a burden for service providers. The new program will introduce greater consistency across service delivery and streamline reporting requirements. It will also introduce more flexibility in the range of services offered, including a greater focus on preventative health and health promotion to help communities address health and wellbeing issues.

Funding for the above activities was sourced from Program 6.1 – Rural Health Services and Outcome 5 Primary Care (Program 5.2 – More Allied Health Services).
Top of page

Medical Specialist Outreach Assistance

The Department worked to improve access to medical specialist services, by providing medical specialists with financial assistance through the Medical Specialist Outreach Assistance Program. This program covers costs associated with delivering outreach services, including travel, accommodation and consulting room hire costs; and for upskilling and/or professional support.

In 2008–09, support was provided to more than 1,430 outreach services to specific rural and remote locations. The support provided enabled rural and remote patients to access medical specialist services in over 100 specialty disciplines and sub specialties including physicians, obstetricians and gynaecologists, paediatricians, psychiatrists and neurologists. In addition, web-based systems supporting telemedicine outreach services such as dermatology and radiology, have had more than 100,000 hits. To help achieve this result, the Department targeted areas of need in each state and the Northern Territory, and worked in consultation with jurisdictional advisory forums representative of stakeholders such as the Queensland Aboriginal and Islander Health Council and Health Consumers of Rural and Remote Australia, to identify which services should be supported. The advisory forums considered areas’ service needs in relation to the whole of the state or the Northern Territory, as well as areas’ capacity to sustain new specialist services, and the cost-benefits of proposed services.

In 2009–10, the Department will expand the Medical Specialist Outreach Assistance Program under the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes to introduce multidisciplinary team care to rural and remote Indigenous communities, and better manage complex and chronic health conditions. The Department will also look at ways in which to address the ongoing challenge of recruiting and retaining appropriately qualified health professionals to deliver outreach services.

Funding for the above activities was sourced from Program 6.1 – Rural Health Services.
Top of page

Improving Health Infrastructure in Rural and Remote Communities

A lack of health infrastructure can be a barrier to recruiting and retaining health professionals in rural and remote communities. It can also hinder the establishment of new health services, or the enhancement of existing services.

In 2008–09, the Department implemented the National Rural and Remote Health Infrastructure Program, to fund essential health infrastructure (capital works and equipment) for rural and remote communities with populations of up to 20,000 people, and strategic service planning for small rural private hospitals. These grants will help improve opportunities for partnerships and multidisciplinary approaches to the delivery of health care in these areas.

The Department conducted three funding rounds under the program, which generated more than 600 applications. This resulted in the major achievement of 97 projects across rural and remote communities receiving funding in 2008–09.

The Department also assisted the establishment and refurbishment of health facilities, which will provide a range of primary care services, including privately insurable health services such as podiatry, physiotherapy, speech pathology and dental health services. Facilities to support the training of medical students and registrars in rural and remote communities were established. Funding was also provided for medical and surgical equipment such as endoscopic and orthopaedic telescopes, monitors and electrocardiogram machines, as well as upgrades to information technology systems to support better patient management. The Department will conduct further funding rounds in 2009–10.

The Department will also work to improve primary care infrastructure and support rural hospitals, through the Health and Hospitals Fund. Discussion on health and medical infrastructure funding can be found in the Outcome 10 Health System Capacity and Quality chapter.

Funding for the above activities was sourced from Program 6.1 – Rural Health Services.
Top of page

Rural Health Initiatives by Outcome

Rural health activities were implemented across several outcomes in 2008–09. The following table lists these activities by outcome.
OutcomeRural Health Activity
Outcome 2Rural Pharmacy Maintenance Allowance/Start-up and Succession Allowance
Rural Pharmacy Workforce Program
Rural Pharmacy Pre-Registration Allowance
Outcome 3Visiting Optometrists Scheme
Higher Bulk Billing Incentives for GPs in Regional, Rural and Remote Areas, Tasmania and Metropolitan Areas (also Outcome 5)
Additional Practice Nurses in Rural and Remote Australia and Other Areas of Need – Medicare Items
Outcome 4Multipurpose Services Program
Rural and Regional Building Fund
Aged Care Adjustment Grants for Small Rural Facilities
Australian Government Aged Care Nursing Scholarship Program
Training for Rural and Remote Aged Care Staff
Viability Supplement for Community Aged Care in Rural and Remote Areas
Outcome 5Practice Incentives Program including: Domestic Violence Incentive; Procedural GP Payment; Rural Loading; and Rural Practice Nurse Incentive
Additional Practice Nurses in Rural Australia and Other Areas of Need – Practice Incentives Program payment
Higher Bulk Billing Incentives for GPs in Regional, Rural and Remote Areas, Tasmania and Metropolitan Areas (also Outcome 3)
Mental Health Services in Rural and Remote Areas (Council of Australian Governments) (also Outcome 11)
Training for Rural and Remote Procedural GPs Program
Rural and Remote General Practice
Rural Locum Relief Program
Prevocational GP Placements Program
Rural Undergraduate Support and Coordination Program
Rural Women’s GP Service
Rural Retention Program
More Allied Health Services Program
HECS Reimbursement Scheme
New General Practitioner Registrars Program (includes Rural Registrars Incentive Payments Scheme)
Workforce Support for Rural General Practitioners
Strengthening the Health Workforce in Rural and Remote Areas and in Indigenous Communities
Outcome 6Multipurpose Centres Program
Royal Flying Doctor Service
Regional Health Services
Building Healthy Communities and National Rural Primary Health Projects
Medical Specialist Outreach Assistance Program
National Rural and Remote Health Infrastructure Program (incorporated the Rural Private Access Program and the Rural Medical Infrastructure Fund in the 2008–09 Health and Ageing Portfolio Budget Statements)
Outcome 10Supporting Women in Rural Areas Diagnosed with Breast Cancer Rural Palliative Care Project
Outcome 11Mental Health Services in Rural and Remote Areas (Council of Australian Governments) (also Outcome 5)
Mental Health Support for Drought Affected Communities Initiative
Outcome 12Additional Practice Nurses in Rural Australia and Other Areas of Need – Training and Support
Rural Clinical Schools
University Departments of Rural Health
Rural Australia Medical Undergraduate Scheme
Australian Rural and Remote Health Professional Scholarship Scheme
Medical Rural Bonded Scholarships
John Flynn Scholarship
Rural Undergraduate Support and Coordination Program
Rural Health Support, Education and Training Program
Rural Health Education Foundation
Rural and Remote Nursing Scholarship Program
Rural Allied Health Undergraduate Scholarship Scheme
Rural Allied Health Undergraduate and Postgraduate Scholarships Schemes
Rural Other Medical Practitioners Program
Advanced Specialist Training Posts in Rural Areas
Rural Advanced Specialist Training Support
Support Scheme for Rural Specialists
Outcome 13Improving Access to Primary Care Services in Rural and Remote Areas (Council of Australian Governments)
Top of page

Performance Information for Outcome 6 Administered Programs

Program 6.1 – Rural Health Services
Indicator:Provision of ongoing primary health services in rural and remote areas.
Reference Point/Target:Services are updated and expanded to reflect needs.
Result: Indicator met.
The capacity of the Royal Flying Doctor Service to deliver health services in rural and remote Australia was improved by providing support for the replacement of 11 aircraft. The aircraft will be used to perform primary aero-medical evacuations and to support the delivery of primary and community health care clinics. The organisation took delivery of five replacement aircraft in 2008–09, which will undergo medical fit out before entering service in 2009–10.

The Department executed 118 funding agreements under the Regional Health Services program to deliver services to over 1,000 small rural and remote communities. Most Regional Health Services received additional funding to enhance or expand services provided.

Forty-three time-limited preventative health activities were funded in 2008–09 to undertake capacity-building activities in rural and remote communities, or to support the health workforce in those communities.
Indicator:Provision of health infrastructure in rural and remote communities to support the establishment of new, or the enhancement of existing, health services.
Reference Point/Target:All funding is committed to health infrastructure projects by 30 June 2009.
Result: Indicator substantially met.
The Department committed funding of $11.2 million (GST exclusive) (66% of the total amount available) in 2008–09 for 97 projects under the National Rural and Remote Health Infrastructure Program. These projects targeted capital works, the refurbishment of health facilities on hospital or health campuses and private practices to establish training facilities.
Indicator:Improved access to medical specialist services for people living in rural and remote communities.
Reference Point/Target:Existing medical specialist outreach services are maintained and additional services and projects are developed.
Result: Indicator substantially met.
The Department delivered 1,430 Medical Specialist Outreach Assistance Program supported services across rural and remote Australia in 2008–09. This compares with 1,842 services in 2007–08, and 1,455 services in 2006–07. The apparent decrease in services provided under the program results from additional one-off expenditure in 2007–08 and a change in the way numbers of Medical Specialist Outreach Services Assistance Program supported telehealth services are reported.
Top of page

Performance Information for Outcome 6 Departmental Outputs

Output Group 1 – Policy Advice
Indicator:Quality, relevant and timely advice for Australian Government decision-making, measured by ministerial satisfaction.
Reference Point/Target:Ministerial satisfaction.
Result: Indicator met.
Ministers were satisfied with the quality, relevance and timeliness of advice provided for Australian Government decision-making.
Indicator:Production of relevant and timely evidence-based policy research.
Reference Point/Target:Relevant evidence-based policy research produced in a timely manner.
Result: Indicator met.
In 2008–09, the Department engaged the Australian Institute of Health and Welfare to draft a report on men’s health that provided advice to the Department on the health and wellbeing of men living in rural and remote areas. This report will inform the development of evidence-based rural health policy advice.
Top of page
Output Group 2 – Program Management
Indicator:Administered budget predictions are met and actual expenses vary less than 0.5% from budgeted expenses measured by comparison of actual expenses against budget.
Reference Point/Target:0.5% variance from budgeted expenses.
Result: Indicator not met.
The actual Administered expenses for Outcome 6 were 4.3% less than budgeted expenses. This was due to a $5.7 million underspend in the National Rural and Remote Health Infrastructure Program because of an unanticipated delay in the announcement of successful projects late in the financial year. Without the underspend in the National Rural and Remote Health Infrastructure Program, the underspend across the remainder of the program amounted to 0.8% from small underspends in the Medical Specialist Outreach Assistance program, and the Regional Health Services Program.
Indicator:Stakeholders participate in program development through a range of avenues, such as surveys and forums.
Reference Point/Target:Regional Health Services conducted annual and biannual forums to discuss program issues.

Medical Specialist Outreach Assistance Program hosts an annual fundholders meeting to review and monitor program administration, and advisory forum in each state and territory to identify service priorities.
Result: Indicator met.
Regular Regional Health Services provider forums were replaced by stakeholder consultations conducted during the reviews of Australian Government funded health programs and rural classifications during 2008–09.

Medical Specialist Outreach Assistance Program advisory forums were held in each state and the Northern Territory to plan and prioritise medical specialist services to be delivered to rural and remote communities. Stakeholder consultations involving Medical Specialist Outreach Assistance Program agencies were also conducted to discuss the implementation of multidisciplinary team care to rural and remote Indigenous communities to better manage complex and chronic health conditions.
Top of page

Outcome 6 – Financial Resources Summary

(A)
Budget
Estimate
2008–09
$’000
(B)
Actual
2008–09
$’000
Variation
(Column B
minus
Column A)
$’000
Budget
Estimate
2009–10
$’000
Program 6.1: Rural Health Services
Administered Items
    Annual Appropriation Bill 1 (Ordinary Annual Services)
159,997
153,113
(6,884)
175,111
Departmental Outputs
    Annual Appropriation Bill 1 (Ordinary Annual Services)
12,340
12,247
(93)
12,390
    Revenues from other sources
214
300
86
226
Subtotal for Program 6.1
172,551
165,660
(6,891)
187,727
Total Resources for Outcome 6
172,551
165,660
(6,891)
187,727
Outcome 6 Resources by Departmental Output Group
Department of Health and Ageing
    Output Group 1: Policy Advice
3,065
2,659
(406)
2,674
    Output Group 2: Program Management
9,489
9,888
399
9,942
Total Departmental Resources
12,554
12,547
(7)
12,616
Average Staffing Level (Number)
91
94
3
91

Top of page

1. A list of rural health initiatives managed under this and other outcomes can be found later in this chapter.


 | TOC | next page

Help with accessing large documents

When accessing large documents (over 500 KB in size), it is recommended that the following procedure be used:

  1. Click the link with the RIGHT mouse button
  2. Choose "Save Target As.../Save Link As..." depending on your browser
  3. Select an appropriate folder on a local drive to place the downloaded file

Attempting to open large documents within the browser window (by left-clicking) may inhibit your ability to continue browsing while the document is opening and/or lead to system problems.

Help with accessing PDF documents

To view PDF (Portable Document Format) documents, you will need to have a PDF reader installed on your computer. A number of PDF readers are available through the Australian Government Information Management Office (AGIMO) Web Guide website.


Produced by the Portfolio Strategies Division, Australian Government Department of Health and Ageing.
URL: http://www.health.gov.au/internet/annrpt/publishing.nsf/Content/annual-report-0809-toc~0809-2~0809-2-3~0809-2-3-6
If you would like to know more or give us your comments contact: annrep@health.gov.au