Rural Health Policy: Meeting the needs of rural communities

Introduction – the place of rural health in overall health policy
	The following goals are set out in the Government’s Medium-Term Strategy for Health and Disability Support Services. Public certainty about access, quality and security of services Timely, equitable and nationally consistent access to elective services Acknowledging the special relationship between Maori and the Crown Decreased long-standing disparities in health status Improved mental health Improved child health Improved disability support services Greater emphasis on population health approaches Well co-ordinated, integrated services that contribute to better health and disability outcomes Intersectoral collaboration between public agencies – education, health and welfare – and various providers to achieve social policy objectives Improved capability and adaptability of the health and disability sector Sustainability of the publicly funded health system A key goal is raising public confidence in the level, mix, quality and structures of health and disability services, including rural services, and making sure they are secure and appropriate to the needs of today and the future. This is achieved through: the commitment to the current configuration of services via the Hospital Services Plan and subsequent developments of collaborative networks of secondary services indicated in the Roadside to Bedside policy major investments in new public hospital facilities making no further change to the current structures within the system (Health Funding Authority and the publicly owned Hospital and Health Services). Rural health is specifically covered under Rural services in Goal 1 of the Medium Term Strategy for Health. Services to people in rural New Zealand are specifically identified in the Strategy as a service area about which the Government wants people to enjoy greater security and confidence. The Government’s policy for rural health and disability support services enables rural people to receive effective appropriate front-line care in their own community, and have timely access to acute emergency services of an agreed standard of care within acceptable modern standards. Decisions on the allocation of health resources must take into account the ongoing needs of rural communities. The increasingly specialised nature of clinical services, coupled with higher levels of technology now employed in medicine, mean that some services are best delivered through regional or national centres of excellence. Used creatively, new technologies, such as telemedicine, telephone triage systems and better transport systems, can enable all New Zealanders to benefit from such services. The Government expects the sector to use technology creatively to facilitate access to health and disability support services for isolated communities. The Government recognises there is diversity among rural communities and their needs and is keen to create opportunities for rural communities to develop local arrangements that suit their needs. They do not need to be the same everywhere – what works well can be used. The Government sees potential for effective alliances and networks to develop between providers at the primary level and between the primary and secondary levels. Provider competencies could be usefully expanded in rural areas, and Government would like to see improved recruitment and retention of rural health professionals. In terms of hospital services, the Government’s rural health policy proposes that people living at a distance from a hospital retain access to a full range of services. Access to public hospital services will be determined on the basis of reasonable need and ability to benefit and not by where a person lives. However, to maintain access to services that are safe, high quality, and operated by sufficiently experienced professionals, people will need to travel for some services, especially the more specialised services. Proposals for new or changed services in rural areas, including those that service particular or at-risk groups, must be carefully assessed before they are launched and communities need to be properly informed of the proposals. Where that base work is done, the Government will encourage initiatives that address particular needs, for example a particular disease like diabetes, or a particular type of service like dental services. The list of proposals would be as short or as long as the community can identify. There are many issues specific to rural health and support services. This document shows how they are being addressed. The Government’s policy for rural health services aims to: enable rural people to receive effective front-line care in their own community organise services around people and their needs recognise the diversity of New Zealand’s rural communities and their differing needs provide timely access to acute emergency services of an agreed standard of care use technology where possible to reduce the impact of isolation establish effective alliances and networks between providers (for example, integrated care organisations, regional referral patterns) develop and maintain skills in rural services offer greater certainty about access to services of a consistent agreed standard create opportunities for rural communities to develop local arrangements that meet their needs. The Government’s priorities for the health and disability sector apply as much to rural communities as to the rest of New Zealand.1 The Government’s rural health policy focuses on the commitment by Government and rural communities to maintaining and improving access to good-quality health and disability support services so that these priorities can be met for rural people. Enabling people in rural communities to access a full range of services means ensuring the recruitment and retention of key health care providers for local communities. It also means carefully taking into account the specific needs of rural people when dividing up health funding. The best solutions come from knowledgeable and committed participants. The submissions to the consultation draft of the Rural Health Policy confirmed that rural people are eager to work in partnership with Government agencies to maintain and improve their services. This document identifies opportunities for rural communities under current policy settings. The Government shares the commitment of rural people to better rural health care. Rural People Age structure About one in four New Zealanders (23 percent) live in rural areas (including small towns of less than 10,000 people). The rural population has a higher proportion of children (aged 0–14 years) and older adults, while having a lower proportion of young people (aged 15–24). Graphs on the age structure of the rural population are included in Appendix 1. Maori rural population Around one in three Maori (32 percent) live in rural areas. One in five rural people (19 percent) are Maori. A map showing the distribution of the rural Maori population is provided in Appendix 2. The age structure of the rural Maori population is younger than that of the non-Maori rural population, with a significantly higher proportion of children and young people and significantly lower proportions of older adults (both the 45–64 years and the 65 years and older age groups). Health status Measures of health status indicate that the health of rural people overall compares favourably with urban people. This is especially so for non-Maori rural people, when measured by life expectancy at birth and at age 65. Of particular concern, however, is the relatively poor health status of rural Maori, compared with urban Maori and with rural non-Maori. Life expectancy tables are included in Appendix 3. Rural people and people living in towns of less than 20,000 population have a significantly higher mortality rate from injuries than urban people but for other major causes of death their mortality rate is similar to or below that of urban people. Rural people have a lower hospital discharge rate than urban people except for neoplasms (cancers). (Refer to figures 6 and 7, Appendix 3.) People with a disability requiring assistance Fourteen percent of people with disabilities live in rural areas, which is significantly less than the 23 percent of the general population in rural areas. Around 10 percent of people with a disability living in rural and-urban areas report requiring some form of assistance on a daily or less frequent basis. There is more of a rural–urban difference for different age groups. In contrast to the general population, children aged under 15 years and adults aged 65 and over who have disabilities make up a smaller proportion of the rural population than the urban population and this trend persists for children and adults who require assistance (refer to table 4 in Appendix 4). This could be because parents of children with disabilities prefer to live near specialist health and disability support services in cities. Older people with disabilities, especially those requiring assistance, also tend to shift to a city or town to be nearer to services. Diversity including socioeconomic differences Rural communities in New Zealand vary widely in their demographic, cultural and socioeconomic characteristics as well as in their geographic features. (Appendix 5 shows the most disadvantaged areas.) There is a close association between socioeconomic hardship and poor health.   FOOTNOTES: 1 A full list of priorities is included in The Government’s Medium-Term Strategy for Health and Disability Support Services, which can be obtained from the Ministry of Health, PO Box 5013, Wellington, or on the Executive Web site.