3 equity of access to health facilities and services

Equity of access to health facilities amp services

lsquoEquityrsquo means fairness Health is a universal human aspiration and a basic human right Inequity is more likely to be experienced by vulnerable or ldquoat-riskrdquo groups Poor health is a consequence of the inequitable distribution of the determinants of health Equity in health is concerned with actively seeking to reduce the differences in health status between different groups or communities Vulnerable or at-risk population groups can include

Aboriginal and Torres Strait Islander (ATSI) people

socio-economically disadvantaged

those living in rural or remote areas those with a mental illness physical or intellectual disability

those who have experienced abuse or neglect as a child

people affected by discrimination social exclusion incarceration and people from cultural or linguistically diverse backgrounds (particularly refugees and survivors of

torture and trauma) Options for reform of Commonwealth and State governance responsibilities for the Australian health system

Problems for patients There is inequitable access to services shaped by place (especially remote and rural location) and financial barriers to care among other factors This is particularly the case for those services funded under fee for service arrangements While the health care you receive should be based on your need where you live and how much money you have too often determines what you actual ly receive and how quickly you receive it 5 Blame- and cost - shifting between levels of government is a major barrier to improvement in the system of care This problem has been addressed in the Commissionrsquos first paper The current split of responsibilities sets up perverse financial incentives for governments whereby one level can lsquowinrsquo financially through measures that cause the other level to lsquolosersquo financially The impact on patients and care providers is significant in the form of unnecessarily fragmented and complex referral and care pathways But cost shifting is also highly inefficient ndash witness the number of state funded hospital beds that are occupied every day by patients who cannot access Commonwealth funded residential or transition care when they need it The resultant blame-shifting (the policies and structures that enable finger-pointing and work against problem-solving) creates an additional barrier to performance improvement 4 Maintain the universality of Medicare A key strength of the Australian health care system is Medicare and the entitlement that all Australians have to the medical and pharmaceutical benefits it provides In accordance with the Commissionrsquos terms of reference Australiarsquos national Medicare system needs to be maintained and potentially strengthened

(Source A paper commissioned by the National Health and Hospitals Reform Commission)

Equity of access to health facilities amp services Activity Complete the cloze passage below

Universal primary health care is particularly ____________________ to disadvantaged people They are more

vulnerable to the social and environmental _______________________ of health

There are pockets of groups that are most at risk of difficulties in ______________________ health care including

those within rural and remote areas families and children during transitional life periods and the Aboriginal and

Torres Strait Islander population For example people from CALD (culturally and linguistically diverse) backgrounds

have received compromised health service due to poor uptake of interpreters by private practices of doctors

dentists community health centres and other medical services These groups continue to have a _______________

expectancy significantly lower than for the general Australian community

Disadvantaged people require ______________________ that are flexible and responsive and take into account

literacy levels income cultural and other issues ____________________ public health promotion and

___________________ initiatives will consider these dimensions including culturally appropriate lifestyle support

Further it is essential that consumers participate in shaping the systems and structures that deliver

___________________ care

Disadvantaged people have poorer access to health care for a range of reasons such as limited

____________________ options to reach health services which are generally less common in geographical areas

experiencing poverty and inadequate financial resources to cover out of pocket expenses and necessary

medication

The health needs of ________________________ people require a strong primary health care system People on

lower incomes and experiencing multiple levels of disadvantage face numerous barriers in accessing the universal

health care system Once engaged they are often heavier users of the health care system

(Source Queensland Council of Social Service

important accessing health education transport

life services determinants effective disadvantaged

4272015 Heal the Bush Temora truck driver has to postpone surgery to treat his cancer because he canrsquot afford the trip to Sydney | dailytelegraphcomau

httpwwwdailytelegraphcomaunewsnswhealshytheshybushshytemorashytruckshydrivershyhasshytoshypostponeshysurgeryshytoshytreatshyhisshycancershybecauseshyheshycantshyaffordshytheshythellip 14

News

dailytelegraphcomauNews

Heal the Bush Temora truck driver has to postponesurgery to treat his cancer because he canrsquot afford the tripto Sydney

by JANE HANSENFrom The Sunday TelegraphOctober 05 2014 1200AM

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Share this story

Temora Shane Botham who is battling cancer has stopped treatment because he can no longer afford it



Source News Corp Australia

SHANE Botham has deadly cancerous tumours in his liver

They need to be removed but when you live five hours out of Sydney and still have to earn a living toughchoices have to be made

Like many county folk Shane Botham has chosen to forgo treatment for financial reasons

ldquoIrsquove had to put surgery off we have harvest time and I have to work the truck otherwise wersquoll go brokerdquothe 45shyyearshyold said

ldquoIrsquove got two tumours in my liver and they want to take halfrdquo

Mr Botham was diagnosed with pancreatic neuroendocrine cancer in 2012 which metastasised to hisliver

Hersquos had the tail of his pancreas removed and his spleen and with an estimated 2 per cent survival ratehe is lucky to still be alive

But the financial cost so far has been phenomenal

In 2012 he had $70000 in the bank but itrsquos all gone now

The truck his only source of income sat idle for five months as he fought for his life during surgery butthe repayments on the truck still had to be made as did the insurance and the $12000 in annualregistration fees

The RTA refused to suspend his registration and his trauma insurance reneged too

But it was the dozen or so round trips to Sydney for chemotherapy surgery scans and checkshyups thatquickly eroded his life savings

ldquoTo go down to Sydney itrsquos a 10 hour round trip thatrsquos $200 in fuel and accommodation is $250 a nightthen therersquos food and tollsrdquo he said

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Shane Botham has had to postpone surgery to treat his cancer because he cannot afford to stop workSource News Corp Australia

The subsidies for isolated patients like the $49 a night for accommodation and 19 cents a litre perkilometre are so paltry he hasnrsquot bothered claiming them

The situation has been compounded by the fact Mr Botham is privately insured with top cover fromMedibank Private

That means hersquos had to pay for some of the PET scans and CT scans because the insurance companywonrsquot

ldquoIrsquove had five or six scans two CT scans an MRI and two PET scans they wonrsquot pay for at $590 a pop Imean the last trip cost me $1200 we were in Sydney for two days and I had a CT scan on day one and aPET scan the next day and accommodation and fuelrdquo Mr Botham said

The inequality in health services for those in the bush is one of the focuses of The Sunday TelegraphrsquosHeal the Bush campaign

ldquoIrsquom on the highest (private health) cover you can get and you try and do the right thing and pay privatewhich is $240 a month but yoursquore better going through the public system because you are discriminatedagainst The best thing is to sell up go on the dole and get everything for nothingrdquo he said

ldquoAnd when you are fighting a deadly disease and trying to work on top of it itrsquos just hard Irsquom just so luckymy bosses havenrsquot put me off subcontracting but Irsquove got to work the truck around treatmentsrdquo

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4272015 NSW rural health drive critical to equality | dailytelegraphcomau

httpwwwdailytelegraphcomaunewsopinionnswshyruralshyhealthshydriveshycriticalshytoshyequalitystoryshyfni0cwl5shy1226986663396 13

News


NSW rural health drive critical to equalityby EditorialFrom The Sunday TelegraphJuly 13 2014 1200AM

ALL Australians are born equal mdash but the way we live and die is often desperately unfair

Today we launch a campaign designed to put pressure on politicians to change things mdash because webelieve all these problems can and must be fixed

Wersquore not asking for Westmead Hospital to be relocated to Dubbo Wersquore asking for a series of small buthighly significant changes that experts say would make an enormous difference

If you happen to live and work in the bush yoursquoll probably die younger and endure more health problemswith greater severity throughout your life than people who live in the cities

Literally from the cradle to the grave mdash from obstetrics to aged care mdash Australia neglects country peoplefor no better reason than itrsquos all a bit too hard

Bush hospitals have lost their obstetric units because the health bureaucrats in Sydney think itrsquos OK forlabouring women to drive several hundred kilometres to have a baby leaving other children behind ordragging them along

Cancer patients are having their breasts and ovaries removed because itrsquos simply too hard to accessradiotherapy and other less aggressive forms of cancer treatment Experts have told us at least 30radiotherapy units are desperately needed throughout the bush and theyrsquore relatively cheap at just $7million to set up and $750000 per year to run Thatrsquos tiny in the context of a $140 billion federal healthbudget

The vast majority of specialist doctors donrsquot work in the bush or participate in telemedicine programs mdashbecause the Government doesnrsquot require them to Thatrsquos another problem that could be easily fixed byrequiring all specialists to do annual rotations in rural areas



At present we require foreignshytrained general practitioners to work in the bush as part of their Australianaccreditation mdash but we donrsquot ask Australian GPs to do the same thing The federal Government payslsquoincentivesrsquo for doctors to work in remote areas but the scheme is so badly designed that you get moremoney to work in Cairns mdash a tropical holiday town serviced by a worldshyclass airport mdash than in Deniliquina remote inland hamlet

Patients who manage the trip to Sydney mdash for chemotherapy for example mdash face enormous bills foraccommodation because the big city hospitals are rapidly closing their onshysite accommodation facilitiesThe federal Government does subsidise patient accommodation mdash but itrsquos a measly $43 a night barelyenough for a bed in a backpacker hostel dormitory or perhaps a caravan park The Commonwealth bycomparison pays $180 per night for its own public servants to stay a night in a hotel

It would be easy to dismiss these concerns by saying nobody asked bushshydwellers to live in the sticksTheyrsquove made a lifestyle choice and we canrsquot expect all Australians to subsidise them

But the truth is this Australia needs the bush Agriculture contributes $155 billion to gross domesticproduct every year creating 16 million jobs Farm exports are worth $32b and agriculture fisheries andforestry exports are $36b every year

All the bush health problems are a result of our own failure to deal with the way country life is changingAgriculture is now hugely more efficient than it was a century ago so fewer people are required to run agiant sheepshystation or a wheat farm Onceshybustling bush towns are diminishing But the people whoremain are absolutely crucial to our nationrsquos economy We should be encouraging more people to move tothe bush to take pressure of our cities and to keep our wonderful heartland alive mdash but whorsquod take afamily to a remote outpost when the health risks are so great

Comments (socialshycomments)

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4272015 Poor access to radiotherapy is killing rural cancer patients | dailytelegraphcomau

httpwwwdailytelegraphcomaulifestylehealthpoorshyaccessshytoshyradiotherapyshyisshykillingshyruralshycancershypatientsstoryshyfni0dguzshy1226986949882 16

Lifestyle

dailytelegraphcomauLifestyle

Poor access to radiotherapy is killing rural cancer patientsby SUE DUNLEVY NATIONAL HEALTH REPORTERFrom News Corp Australia NetworkJuly 12 2014 1031PM

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Tony and Julie Ryswyk with daughters Holly 14 and Madi 13 Tony has secondary cancer in his liverThey live in Kyneton he has been having chemotherapy for three years travelling back and forth fromMelbourne Picture Tim CarrafaSource News Corp Australia



CANCER patients in the bush are up to 30 per cent more likely to die than those living in the citybecause they canrsquot access radiotherapy treatment

And they are waiting longer to get chemotherapy

The Royal Australian and New Zealand College of Radiologists has estimated 18000 cancer patients aremissing out on lifesaving radiotherapy every year many of them in rural areas

A recent study published in the Medical Journal Australia found death rates from colorectal cancer rose 6per cent for every 100 kilometres a patient lived away from a radiotherapy facility

Those living 200shy399km away were 30 per cent more likely to die

This is even though it costs just $7 million to install a linear accelerator to provide radiotherapy and around$750000 a year to staff it

Medical experts are pushing for the roll out of more radiotherapy units in the bush as one of the best waysto stop rural patients dying younger

Many rural cancer patients are refusing lifesaving radiotherapy because they canrsquot afford time away fromtheir farms or families to travel to major cities for up to seven weeks

Incredibly some mothers who canrsquot afford to spend six weeks away from their family while they haveradiotherapy in the city have their breasts removed when cancer is detected

Medical experts are pushing for the roll out of more radiotherapy units in the bush as one of the best waysto stop rural patients dying youngerSource News Limited

ldquoPeople who have appropriate indicators for radiotherapy are missing out on their treatmentrdquo RoyalAustralian and New Zealand College of Radiologists president Professor Chris Milross said

Professor Milross applauds the previous Labor government for providing $560 million to set up 26 regionalcancer centres and dramatically expanding access to radiotherapy in the regions

ldquoThe day they opened they were fully booked and we have to look to providing more linear acceleratorsin themrdquo he said



However Professor Milross says ldquoif you live in Bourke and Orange Tamworth it is still not convenientyoursquove got to travelrdquo

A look at the map shows most of these new centres hug the eastern coast of Australia very few helpthose in western NSW Queensland or Victoria or inland South Australia and the Northern Territory

A study by the college found Australia would need 40 new linear accelerators by 2017 to cope withgrowing demand

University of NSW radiation oncology expert Professor Michael Barton says around a third of these newmachines would be needed in rural Australia

Professor Michael Barton is campaigning for more linear accelerators in the bush by 2017 to cope withgrowing demandSource News Limited

To be viable a radiotherapy unit needs to treat around 1000 new cancer cases a year and this requires acatchment population of 200000 to 250000 a year he said

It would be better to put many of the new units in existing cancer centres to take advantage of staff andexpertise there Professor Barton said

ldquoItrsquos not just a matter of putting radiotherapy yoursquove got to put in chemotherapy and MRI and PETscanning for people to have their treatment properly stagedrdquo he said

Canspeakrsquos Dr Ian Roos says there is a good argument to put a radiotherapy centre in the GoulburnValley

Cancer Council Queensland says research shows more than 250 regional Queenslanders die of cancereach year because they live outside urban centres

Queensland currently has 19 public radiation therapy services and 16 private radiation therapy servicesThis equates to about 145 linear accelerators per 1000 new cancer cases in comparison to an Australianbenchmark of 16 linear accelerators per 1000 new cases

But the Council says existing radiotherapy units together with new ones under construction in



Rockhampton Springfield and Hervey Bay are enough to cater for the rural population

It is better for more remote patients to be treated in specialist cancer centres where they have access toleading oncologists even if it meant they had to travel the council said

Doctors say part of the problem is rural cancer patients get diagnosed and treated late because they haveto wait to see a doctor wait to get a diagnostic test and wait to have a biopsy

Assistant Health Minister Fiona Nash said because she lives in a rural community she appreciateschallenges first handSource News Corp Australia

The Assistant Minister for Health Fiona Nash said because she lives in a rural community she appreciateschallenges first hand

The differences in cancer survival outcomes were not only due to whether or not cancer services areavailable nearby but also factors such as differences in stage of presentation different lifestyle factorsand varying socio economic status a spokeswoman for Senator

Nash said

All Governments have contributed to building and servicing better cancer infrastructure in regionalAustralia including the provision of 25 Regional Cancer Centres (RCCs) the spokeswoman said

What Australia needs to adequately meet demand for radiotherapy by 2017

40 new linear accelerators

$3 million per linear accelerator

$4 million per radiotherapy bunker

$750000 a year to staff each radiotherapy centre

1 75 extra radiation oncologists

683 extra radiotherapists

4272015 Rural health changes needed to prevent country people dying three years earlier than those in the city | dailytelegraphcomau

httpwwwdailytelegraphcomaulifestylehealthruralshyhealthshychangesshyneededshytoshypreventshycountryshypeopleshydyingshythreeshyyearsshyearliershythanshythoseshyinshytheshycityhellip 16

Lifestyle


Rural health changes needed to prevent country peopledying three years earlier than those in the city

by SUE DUNLEVY NATIONAL HEALTH REPORTERFrom News Corp Australia NetworkJuly 13 2014 1200AM

Emergency News Corp Australia is pushing for specialist trainees to do an annual rotation in the bushPic ThinkstockSource Supplied



THEY grow the food we eat and generate $32 billion in exports but the people who make up thebush heartland of Australia are dying three years earlier because of poor access to healthcare

Today News Corp Australia launches a fiveshyweek campaign asking state and federal governments tomake small but significant changes that will dramatically improve the health crisis in the bush

We will focus on the policy changes needed to improve cancer care in the bush maternity servicessubsidies to encourage doctors to work in rural Australia patient travel subsidies and aged care

A cancer diagnosis is shattering no matter where you live but few Australians realise their chance ofsurviving the disease depends on geography

Rural cancer patients are up to 30 per cent more likely to die than those living in the city because theycanrsquot access radiotherapy treatment needed to control their cancer

News Corp has identified a number of rural towns that need a radiotherapy centre to help cut the cancerdeath rate in the bush

It costs just $7 million to put in a linear accelerator to deliver the treatment and $750000 a year to staff it

A shortage of medical specialists in rural towns means rural patients often have to travel to the city to getthe specialist care they need Picture ThinkstockSource News Limited

In a national health budget of $140 billion a year it should not be too hard to find the funds to put more ofthese life saving machines in our rural heartland

The ability to be born and bred in the bush is fast diminishing with many country birthing units closeddown and opportunities to attract GPs with obstetric training diminishing



Professor David Tiller from University of Sydneyrsquos School of Rural Health has called on both State andFederal governments to build specialist training facilities for obstetrics in rural settings

As an obstetrician if you get appointed to a big city hospital you should also be appointed to carry outrotational practice in a rural facility he says

The government could also consider making it a condition all doctors including obstetricians spend acertain period each year working in a rural town in return for their Medicare provider number giving themaccess to Medicare benefits

A shortage of medical specialists in rural towns means rural patients often have to travel to the city to getthe specialist care they need

These travel costs can run into the thousands of dollars but state government funded patient travelschemes go nowhere near reimbursing the true cost

Dr Ian Roos a spokesman for Canspeak a cancer patient lobby group says the subsidy amounts toldquowhat it costs you to put your pet dog in a kennel while you get your cancer treatmentrdquo

Campaigner Canspeak spokesperon Dr Ian Roos is lobbying for better health services in the bushSource News Limited

It is time for our state governments to subsidise the true cost of travel for healthcare in the city andreimburse patients at least 63 cent per kilometre for using their private car for travel and raise theaccommodation allowance to tax office or public service rates

There are half as many medical practitioners per 1000 population in the bush compared to our cities

Although the federal government is paying doctors hundreds of thousands of dollars in incentives to



relocate to a rural area and stay there the scheme is skewed to encourage doctors to move to attractivecoastal tourist towns rather than tiny bush outposts

A News Corp investigation has found a doctor who relocates to Cairns or Townsville will get double themoney on offer for a doctor who moves to Orange Gundagai and Deniliquin

The Coalition pledged to overhaul the scheme in the election to recalibrate the incentives to help getdoctors into smaller towns where they are most needed

Aged and Community Services Australia has warned many aged care facilities in rural and remote areasoperate ldquoon the cusp of viabilityrdquo because they have fewer residents and government subsidies are notenough to keep them viable

These rural facilities are facing major challenges under the aged care reforms that took effect on July 1that will see a shift to a more user pays system in aged care

There are half as many medical practitioners per 1000 population in the bush compared to our cities PicThinkstockSource Supplied

WHATrsquoS NEEDED

DOCTORS

Force all specialist trainees to do an annual rotation in the bush

Overhaul incentive schemes so GPs get extra pay to work in isolated inland towns

CANCER



Open more radiotherapy centres

NURSES

Increased funding to bush hospitals to hire more chemotherapy nurses

DIAGNOSIS

Increased funding to bush hospitals for MRI and PET scanners

CHILDBIRTH

Introduce obstetric training programs at country hospitals

Reopen and staff birthing centres at country hospitals

PATIENTS

Lift patient mileage subsidy from 19ckm to 63ckm

Lift patient accommodation subsidy from $43 to $180 per night

5 Wrsquos summary Equity of access to health facilities amp services

Students list information that answers who what when where why related to learning about

equity of access to health facilities amp services

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Equity of access to health facilities amp services Activity Complete the cloze passage below

Universal primary health care is particularly ____________________ to disadvantaged people They are more

vulnerable to the social and environmental _______________________ of health

There are pockets of groups that are most at risk of difficulties in ______________________ health care including

those within rural and remote areas families and children during transitional life periods and the Aboriginal and

Torres Strait Islander population For example people from CALD (culturally and linguistically diverse) backgrounds

have received compromised health service due to poor uptake of interpreters by private practices of doctors

dentists community health centres and other medical services These groups continue to have a _______________

expectancy significantly lower than for the general Australian community

Disadvantaged people require ______________________ that are flexible and responsive and take into account

literacy levels income cultural and other issues ____________________ public health promotion and

___________________ initiatives will consider these dimensions including culturally appropriate lifestyle support

Further it is essential that consumers participate in shaping the systems and structures that deliver

___________________ care

Disadvantaged people have poorer access to health care for a range of reasons such as limited

____________________ options to reach health services which are generally less common in geographical areas

experiencing poverty and inadequate financial resources to cover out of pocket expenses and necessary

medication

The health needs of ________________________ people require a strong primary health care system People on

lower incomes and experiencing multiple levels of disadvantage face numerous barriers in accessing the universal

health care system Once engaged they are often heavier users of the health care system

(Source Queensland Council of Social Service

important accessing health education transport

life services determinants effective disadvantaged



News




Sharetimes

Share this story


















dsidaros
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facebook



News



















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Lifestyle





































WHATrsquoS NEEDED

DOCTORS



CANCER




NURSES


DIAGNOSIS


CHILDBIRTH



PATIENTS
































News




Sharetimes

Share this story


















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facebook



News



















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DOCTORS



CANCER




NURSES


DIAGNOSIS


CHILDBIRTH



PATIENTS














































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facebook



News



















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dsidaros
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WHATrsquoS NEEDED

DOCTORS



CANCER




NURSES


DIAGNOSIS


CHILDBIRTH



PATIENTS








































facebook



News



















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dsidaros
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dsidaros
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Lifestyle



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Nash said











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WHATrsquoS NEEDED

DOCTORS



CANCER




NURSES


DIAGNOSIS


CHILDBIRTH



PATIENTS
































News



















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dsidaros
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DOCTORS



CANCER




NURSES


DIAGNOSIS


CHILDBIRTH



PATIENTS






































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DOCTORS



CANCER




NURSES


DIAGNOSIS


CHILDBIRTH



PATIENTS
































Lifestyle



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Nash said











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WHATrsquoS NEEDED

DOCTORS



CANCER




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DIAGNOSIS


CHILDBIRTH



PATIENTS



































































Nash said











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WHATrsquoS NEEDED

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CANCER




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DIAGNOSIS


CHILDBIRTH



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WHATrsquoS NEEDED

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CANCER




NURSES


DIAGNOSIS


CHILDBIRTH



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WHATrsquoS NEEDED

DOCTORS



CANCER




NURSES


DIAGNOSIS


CHILDBIRTH



PATIENTS
































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WHATrsquoS NEEDED

DOCTORS



CANCER




NURSES


DIAGNOSIS


CHILDBIRTH



PATIENTS






























































WHATrsquoS NEEDED

DOCTORS



CANCER




NURSES


DIAGNOSIS


CHILDBIRTH



PATIENTS


















































WHATrsquoS NEEDED

DOCTORS



CANCER




NURSES


DIAGNOSIS


CHILDBIRTH



PATIENTS






































WHATrsquoS NEEDED

DOCTORS



CANCER




NURSES


DIAGNOSIS


CHILDBIRTH



PATIENTS

































NURSES


DIAGNOSIS


CHILDBIRTH



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Documents

3 equity of access to health facilities and services