A Stronger Rural Health Strategy
It is widely recognised that people in rural and remote
areas of Australia experience poorer health outcomes, lower life expectancy and
poorer access to health services than those living in metropolitan areas.
To address shortages of health workers in rural and remote areas, the
Government has announced A Stronger Rural Health Strategy package and
allocated funding of $83.3 million over five years from 2017–18.
The Government says the Strategy will deliver around an additional 3,000
specialist general practitioners (GPs) and over 3,000 nurses, as well as
hundreds of allied health professionals in rural areas over ten years, for a
total investment of $550 million. However, it is not clear
from the budget papers what specific measures count towards this total investment
Rural medical workforce
A range of measures for the medical workforce are included
in the package.
A Murray-Darling Medical Schools Network supporting
end-to-end training for students to study medicine in the regions will be
established. The network will involve seven university medical schools (subject
to finalisation of contractual arrangements and the universities meeting
accreditation requirements). A pool of Commonwealth
Supported Places (CSPs) taken from existing medical school allocations will be
established. Commencing in 2021, the pool will comprise up to 60 medical CSPs
to be allocated by participating universities every three years and redistributed
between providers through a competitive process. This will provide flexibility
to allow rural health workforce priorities to be more quickly addressed as they
emerge. These priorities will be identified through a new health workforce data
tool called HeaDS UPP.
Thirty CSPs will be allocated in the first round to a new
medical school in Orange. Universities with reduced medical CSPs will be
allowed a commensurate increase to their international medical enrolments, as a
transitional arrangement. $95.4 million has been earmarked to establish
the network. However, no new CSPs will be funded.
Legislation is not required; however, the establishment of the network and pool
arrangements may need to be specified in the triennial Commonwealth Grants
Scheme funding agreements between the participating universities and the
To enhance training opportunities in rural areas, two new
Junior Doctor Training programs will be introduced. The Rural Primary Care
Stream will provide educational support for junior doctors to train in rural
general practice. The Private Hospital Stream will provide salary support for
junior doctors to work in private hospitals. Concurrent to this will be the
development by the National Rural Health Commissioner of a National Rural
Generalist pathway. Legislation is not
New fee arrangements that support medical graduates to
pursue additional qualifications as vocationally registered (VR) general
practitioners (GPs) will be introduced. Australian trained non-VR
doctors who work in Modified Monash Model (MMM)
remoteness classification areas 2–7 will be able to claim 80 per cent of the
Medicare rebate that is claimable by VR GPs, representing an increase on the
Medicare rebate they can currently claim. Support will be offered to existing
non-VR GPs to upgrade their qualifications. When a new non-VR GP begins the
pathway to full registration (Fellowship) they will be able to claim the full
Medicare rebate. It is hoped that
supporting non-VR GPs to attain higher qualifications in rural areas will help
address the maldistribution of the medical workforce in these areas. Legislation
will not be required, as changes to Medicare fees are made through legislative
At the same time under a separate Home Affairs budget
measure, the number of visas for overseas trained doctors (OTDs), who provide a
significant proportion of Medicare-funded services in rural areas, will be capped
at 2,100 per year from January 2019. Although not detailed in
the budget papers, media reports suggest this will result in a decrease
of 200 OTDs per year. As the pool of new OTD doctors
declines, Medicare expenses in the form of rebates that are paid to them should
also fall, resulting in estimated savings of $415.5 million over four
years. Savings will be used to
fund health policy priorities. Imposing a cap on OTDs
does not require legislation.
The geographic eligibility criteria for rural bulk billing
incentives will be updated. Incentives are available to doctors in designated
rural and remote areas for bulk billing patients under 16 or those holding a
Commonwealth concession card. The geographic eligibility criteria that are
currently applied are based on out-dated population figures; these will be
updated and be based on the MMM remoteness classification areas 2–7.
Legislation will not be required as the changes can be achieved through legislative
Other medical workforce measures include:
the return of service obligations for medical students under bonded medical
training programs by introducing an optional three year bonded period (down
from six years) and
GP training arrangements provided through the Royal Australian College of
General Practitioners and the Australian College of Rural and Remote Medicine
for GPs to gain vocational recognition and providing 100 additional vocational
training places through the Australian General Practice Training Program from 1
Nursing and allied health workforce
The package includes a number of measures to support the
nursing and allied health workforces, in recognition that rural areas also
experience shortages of these health professionals.
A new Workforce Incentive Program will be established from
1 July 2019, which will provide targeted incentives for general
practices to employ allied health professionals and targeted incentives for
doctors to practise in non-metropolitan areas. Existing GP, nursing and allied
health incentive programs will be replaced with the new Workforce Incentive
Program. Eligible practices who employ allied health professionals can receive
incentive payments up to $125,000 per year, with a rural loading for those in
MMM classification areas 3–7. Doctors located in MMM classification areas 3–7
areas may receive a maximum payment of up to $60,000. Around 5,000 practices
and more than 7,000 doctors are expected to be eligible for the payments.
The role of nursing in team-based and multidisciplinary
primary care service settings will be enhanced through continued funding to the
Australian Primary Health Care Nurses Association, which helps nurses to
deliver care in primary care settings. An independent review of the nursing
curricula and pathways into nursing will be conducted.
Support for Aboriginal and Torres Strait Islander health
professional organisations will continue through increasing investment in
Aboriginal and Torres Strait Islander Health Professional Organisations of
around $1.6 million a year. In addition, a new primary care funding model will
be implemented from 1 July 2019, in consultation with the Indigenous
Most stakeholders have been generally supportive of the
package. The Rural Doctors Association of Australia (RDAA) and the National
Rural Health Alliance (NHRA) both welcomed the Strategy. The RDAA described it
as ‘a multi-pronged approach to supporting improved medical workforce
distribution to rural and remote Australia’. The NHRA welcomed
funding ‘to help fill the health workforce gaps’ and described the new
Workforce Incentive Program as the ‘first step in increasing very low numbers
of allied health workers in rural and remote areas’.
The Australian Medical Association (AMA) also welcomed the Strategy.
For several years, there have been calls including from some
in the National Party, to establish a Murray Darling Basin Medical School.
These calls have faced opposition from some medical groups, including the AMA,
who argue that there is an oversupply of medical graduates
and the Australian Medical Students Association (AMSA) who argued that increasing
the number of medical graduates would mean a higher number missing out on
limited internship placements. In announcing the
Murray-Darling medical schools network, the Government appears to have
addressed some of these concerns by agreeing to not increase the total number
of medical CSPs available overall. The AMA described the decision to ‘reject
the proposal for a stand-alone Murray Darling Medical School in favour of
network’ as ‘a better approach’. The AMSA Rural Health
group also expressed ‘cautious optimism’ over the announcement.
In relation to the visa changes for OTDs, Dr Michael Gannon,
President of the AMA has reportedly questioned whether the savings will be
achievable, as other medical providers will still be available to provide the services
no longer provided by OTDs.
Australian Institute of Health and Welfare (AIHW), ‘Rural
& remote Australians: overview’, AIHW website.
Australian Government, Budget
measures: budget paper no. 2: 2018–19, pp. 106–107.
Department of Health (DoH), ‘Stronger
Rural Health Strategy–delivering high quality care’, Budget 2018–19 Fact
Sheet, 8 May 2018.
The universities involved include the University of NSW (Wagga Wagga),
University of Sydney (Dubbo), Charles Sturt University/Western Sydney
University (Orange), Monash University (Bendigo, Mildura), University of
Melbourne/La Trobe University (Shepparton, Bendigo, Wodonga).
Rural Health – Teaching – Train in the regions, stay in the regions’, Budget
2018–19 Fact Sheet, 8 May 2018.
Department of Education, ‘Commonwealth
Grants Scheme’, website. The agreements are made under the Higher Education Support
Rural Health –Training–improving access to training in rural areas and the
private sector through junior doctor training’, Budget 2018–19 Fact
Sheet, 8 May 2018.
VR GPs complete a three year training program that allows them to
pursue a career as a specialist general practitioner. Royal Australian College
of GPs, ‘Becoming
a GP in Australia,’ webpage.
The Modified Monash Model (MMM) is a new geographical classification
system, using up-to-date population data, which the Government is using to
address the maldistribution of medical services across Australia. DoH, ‘Modified
Monash Model’, webpage. A searchable map of MMM locations is available via
Rural Health – Training – improved access to Australian trained general
practitioners and quality care’, Budget 2018–19 Fact Sheet, 8 May 2018.
Currently, rebates for non-VR GPs are considerably lower than for VR GPs.
Insurance (General Medical Services Table) Regulations 2017.
measures: budget paper no. 2: 2018–19, p. 134.
to let in fewer overseas doctors, in one of biggest budget savings’, The
Guardian (Australia), 8 May 2018; S Parnell, ‘Junior
medics’ reason to go bush’, The Australian, 9 May 2018.
OTDs who work in a District of Workforce Shortage are exempt from the Section
19AB restrictions of the Health Insurance Act 1973, which prohibits OTDs
from accessing a Medicare provider number. See Department of Human Services
provider number for overseas trained doctors and foreign graduates’, DHS website.
The difference between the Medicare rebate for exempt OTDs and the 80% of the
fee that non-VR GPs will be able to claim appears to constitute most of the
measures: budget paper no. 2: 2018–19, p. 134. This measure
constitutes the largest saving in this year’s budget. See Australian
Overview, p. 36.
Rural Health—Recruitment and retention—supporting rural and remote areas
through improved targeting of rural bulk billing incentives’, Budget
2018–19 Fact Sheet, 8 May 2018.
Rural Health —Recruitment and retention—addressing doctor shortages across
rural and remote areas by strengthening bonded program ’, Budget 2018–19
Fact Sheet, 8 May 2018.
Rural Health—Training—streamlining general practice training to produce
Australian trained general practitioners where they are needed’, Budget
2018–19 Fact Sheet, 8 May 2018. See also, Budget measures:
budget paper no. 2: 2018–19, p. 107.
Rural Health—Recruitment and retention—Workforce Incentive Program’, Budget
2018–19 Fact Sheet, 8 May 2018.
Rural Health—Recruitment and retentions—strengthening the role of the nursing
workforce’, Budget 2018–19 Fact Sheet, 8 May 2018.
M McCormack (Deputy Prime Minister) and J McVeigh (Minister for Regional
Development, Territories and Local Government), Regional
Australia—A stronger economy delivering stronger regions, ministerial
budget statement, 2018, p. 92.
Rural Doctors Association of Australia (RDAA), ‘Budget
delivers for rural health’, media release, 8 May 2018.
National Rural Health Alliance, ‘Rural
health budget $$ welcome but not enough’, media release,
8 May 2018.
Australian Medical Association (AMA), ‘AMA
welcomes 'Stronger Rural Health Strategy'’, media release,
9 May 2018.
J Dewar, ‘Regional
unis face ‘triple whammy’’, The Australian, 24 May 2017; ‘Regional
taxation key to growth’, Central Western Daily, 30 June 2016.
S Parnell, ‘More
doctors not the answer’, The Australian, 4 May 2018.
welcomes 'stronger rural health strategy'’, op. cit.
AMSA Rural Health, ‘Budget:
rural health in focus’, media release, 10 May 2018.
N Evans, ‘Visa
saving questioned by doctors’, West Australian, 10 May 2018.
All online articles accessed May 2018.
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