This Chapter examined the context for MSOAP and VOS. It highlighted the key challenges for rural and remote populations in a number of areas, such as demography, health status and workforce issues. These are not mutually exclusive; they all impact on one another. Nevertheless, they have been outlined here to provide a better context for examining issues in relation to the programs in later chapters.

The terms ‘rural’ and ‘remote’ are used routinely, yet there are varying degrees of rurality and remoteness that are important to understand in the context of MSOAP and VOS. That is, rurality and remoteness can be measured based on the density of the population inhabiting an area, distance from capital cities and other major metropolitan areas, road distance from major services (or ‘service centres’), or a combination of the above. The current preference (since 2008) for administration of Australian Government programs is the ASGC Remoteness Areas, which mainly uses road distance as a measure of access. It is the approach applied across all MSOAP programs from 1 July 2011.

A second challenge is the health status of rural and remote populations. The health of Australians living in rural areas rates more poorly than that of Australians living in major cities across a range of health status measures. These include life expectancy, self-reported health status, cancer incidence and chronic disease prevalence. They also tend to have poorer determinants of health, including tobacco use and risky or high risk alcohol consumption. A major contributor to the lower relative health status and determinants of health of rural and remote regions is the high proportion of Aboriginal and Torres Strait Islander people living in these regions compared with metropolitan regions.

A third challenge is that of viability for specialists and optometrists considering practice in rural and remote regions, which is impacted by having sufficient volumes of patients, and the likelihood of patients not having private health insurance (which limits the practitioner to bulk billing). In addition to these, professional and social issues play a part in specialists and optometrists deciding whether or not to practice in these regions. The challenges for private practice specialist medical practitioners and optometrists in providing services to rural and remote populations show up in MBS expenditure figures and in analyses of location of the medical workforce across remoteness areas.

Over the years, governments (including Commonwealth and state and territory) have invested in a variety of programs to address rural health issues and to expand the health workforce and/or access to health services for rural and remote populations. These schemes may be in the form of incentives provided in mainstream programs (such as MBS), and in targeted programs.

The recent national health reforms have introduced LHNs and Medicare Locals. In particular, Medicare Locals are aimed at achieving greater integration between primary, secondary and tertiary health care provider organisations, and improve co-ordination of care across these. The health care reforms have the potential for greater engagement of various players in planning and service development to meet local needs. However, the impacts are as yet unknown.