Health by and affects a broader socio-political environment

Health care is a system which involves inputs, throughputs
and outputs.  It is both affected by and
affects a broader socio-political environment (Duckett & Willcox, 2015).
The health of any given population can be determined by this system and its
appropriateness to their needs. The health outcomes of those living in rural
and remote areas of Australia experience poorer outcomes than those living in
urban areas. Factors that influence their health include poor health and aged care
service viability, absence of infrastructure development, costs incurred due to
distance and remoteness, and the unbalanced distribution of the health
workforce (Australian Government, 2010). 
What is put into the healthcare systems has an affect on the outputs and
therefore is a determent of the health of the population it serves. Finance,
infrastructure and workforce inputs will be analysed in this assignment and
their output on the heath of those living in rural and remote Australia discussed.

Whilst Australia is a large country it has a comparatively small
population which is centred around a number of major urban areas, over two
thirds of the population (69%) live in major cities. 9% live in outer regional
areas and 2.3% in remote or very remote areas (Australian Institute of Family
studies, 2011). Rural and remote Australia has many important differences to
urban areas.  Outside the major cities
population becomes more isolated, health outcomes are less favourable, access
to health services becomes more problematic, prices increase and the capacity
to meet these increases decreases (Wakerman & Humphrey 2008). These factors
all influence the health of this population.

System theory can be used to help us understanding health
care structures, it’s processes and outcomes and their connections within a
healthcare system in a clear and concise way (Hayajneh, 2007).  This is a theory which uses a theoretical
perspective to analyse a phenomenon holistically and doesn’t just view it as
the totality of elementary parts. In an attempt to comprehend a unit’s
organisation, functioning and outcomes the way in which the parts interact and
the relationship they have is emphasised (Meles, Pels, & Polese, 2010).
This theory describes inputs, throughputs and outputs of a phenomenon and this
essay will analyse how inputs and outputs may determine the health of those
living in rural and remote Australia.

Inputs can be defined as that which is put into a healthcare
process and is transformed by this process into an output (, n.d.). They
can be broken down into three elements; funding arrangements, infrastructure
and linkages and workforce. There is also a less definable input into
healthcare which is described by Duckett & Willcox (2015) as ‘political and
social support’ which is reflected in the trust the people place in the
system.  Outputs of the health care
system can be on a person level such as number of patients treated but also on
a much wider level, its effect on communities, research outputs and changes in
communities. They are often unevenly distributed across section of the
community with some faring better than others. 
Some of the outputs of health care such as pathology results ultimately
become inputs into the process (Duckett & Willcox, 2015).



Funding for global health has grown over the last years but
funding alone does not mean progress. 
Rather resources should be used effectively to ensure the required
results (Frenk, 2010). Funding is provided by the Australian Government in an
attempt to specifically affect the health and wellbeing of those living in
rural and remote areas.  Specific purpose
payments are also made to States and Territories through Government assistance
which is directed at those living in rural and remote areas (Department of
Infrastructure and Regional Development, 2017). In 2017–18 the Australian
Government will provide $4.4 million in order to support the National Rural
Health Commissioner who will work with rural, regional and remote communities,
the health sector, universities and colleges and across all levels of
government to ensure that the health needs in rural and remote Australia are
specifically targeted and addressed, and rural practice is seen as a priority.
For this input to positively affect health, the physical, mental and social health
status of individuals and communities need to be addressed but also the
organisational, social and cultural measures that also generate their health need
to be attended to (Bourke, Humphreys, Wakerman, & Taylor, 2012). Large
populations of people from Aboriginal and Torres Strait Islander backgrounds are
to be found in rural and remote areas of Australia, whose ideas of health
extends to a “state of complete physical, mental, and social well-being” (WHO,
1978) service providers should work with this community and its elders to
ensure these specific health needs are being met in order for the financial
input to positively determine the health of this group.

In a recent media release The Hon. Greg Hunt MP stated that
private health insurance (PHI) is an essential and valuable part of the
Australian health system and that younger Australians are to be encouraged to
take it up (Hunt, 2017).  However, those
living in outer rural and remote areas of Australia do not appear to get much
back for their money and are, in fact, just adding to a fund pool which keeps
prices down for those living in metropolitan areas (Butt, 2017). The Government
has said that in support of those living in rural and remote areas they are
allowing insurers to offer travel and accommodation benefits to those who need
to travel for treatment.  This input may
enable them to travel to private hospitals to see the doctor of their choice
without incurring further expense thus increasing their opportunities to access
good quality healthcare.

Effective use of funding allows service providers to target the
specific health needs of the community they serve and their outcomes be
measured on equity, efficiency and effectiveness (Willcox & Duckett, 2015)
not just count patients treated or length of hospital stay. This aligns with
Frenk’s (2010) idea of targeting interventions for improvements. A viable
health sector is a major component of the infrastructure of a community which
helps to attract new firms who provide jobs and economic growth to the area
(Doeksen & Schott, 2003). Financial input into rural health has an economic
output for the rural community.


High quality infrastructure is an essential component of a
society’s growth and development. 
Inadequate facilities and services can adversely affect the quality of
life of those in that society (Doeksen & Schott, 2003). In rural and remote
areas health services are very different to those in cities, facilities tend to
be smaller but despite this they play an important role in the provision of
integrated health services throughout the community. They are more reliant on primary
health care services, particularly those provided by General Practitioners.
Adequate community and social infrastructure is vital to these regions (Anon.,
2017). The Australian Government has established Rural and Regional Health
Australia which as one of its aims will fund health infrastructure. The
National Rural Health Alliance believes that a package of measures is required
which includes greater infrastructure investment for rural hospitals, and a
greater number of Multi-Purpose Services with their scopes of practice extended
(National Rural Alliance, 2013).  In 2012
the Government introduced a new grant specifically for rural and remote areas,
The National Rural and Remote Health Infrastructure Program (NRRHIP) which aims
to advance access to health services by providing funding to rural and remote
communities in which a lack of infrastructure is a barrier to new services
being established and existing services being enhanced (Grant Solutions,
2017).  This input had the aim of
improving access to walk-in/walk-out primary healthcare and medical facilities,
improve the viability of rural private hospitals and increase the range of
privately insurable health services. Federal Government has assumed greater
funding responsibility from the states and governance is being devolved to
local areas thus providing a better opportunity for integrated regionally based
governance (Australian Government, 2010). 
Horizontal equity is one measure of an equitable health service which
will help people in rural and remote areas to access health services and, thus,
achieve similar health outcomes to those living in more developed areas (Tham
& Wood, 2008).

Increased infrastructure improves equity of access for those
living in the country, which can be measured by the number of hospital beds and
the local facilities but perhaps more importantly, by the standards of quality
and the safety of these services, the configuration of services provided with
the needs of the locals and the existence of planned and effective systems
which are able to provide safe and predictable access to hospital services at
local, regional and metropolitan centres (Anon., 2017). The ability to receive
high quality, appropriate care close to home has benefits for personal, family
and work life. which in turn, benefits the community as a whole. Greater
investment in infrastructure may improve partnerships opportunities,
multidisciplinary approaches and recruitment which will in turn lead to gains
in services available to those living in rural and remote areas with the health
benefits attached to this (Department of Health, 2013).






The shortage of health practitioners is a problem which is
being experienced globally but rural and remote areas are experiencing this
greatly. This lack of workforce has a negative consequence for the accessibility
of health services and health outcomes for this community (Australian
Government Department of Health and Ageing, 2008). Retention of staff is also
an issue for rural and remote areas.  The
Commonwealth provides a variety of enticements, both financial and
non-financial, which aim to attract and retain healthcare practitioners in rural
and remote areas. As part of the 2009-10 Federal Budget a $134.4 million Rural
Health Workforce Strategy was announced. A key element of the Government’s
rural workforce strategy is financial incentives aimed at rural doctors, the provision
of $116.4 million in 2012-13 demonstrates the ongoing investment the Government
is making in an attempt to retain staff. The Royal Flying Doctor service is one
model of care which is fit-for-purpose in rural and remote areas (Hill &
Harris, 2008).  Access to healthcare
services has also been enhanced with the development of Healthdirect and
eHealth and telehealth services. Healthdirect provides 24-hour health advice
for non-urgent assistance, technology is used by eHealth to keep a secure
online record of health information which improves communication between
medical professionals and Telehealth involves remote consultations with health
practitioners thus improving accessibility.

High quality health care is generally dependant on good
workforce retention because it is offers staff with increased experience and
skills and improved continuity of care for patients (Humphreys, Wakerman,
Wells, & Taylor, 2007).  A more
stable, experience workforce with a deep understanding of the community they
serve allows for greater opportunity for the development and implementation of
preventative and screening medicine.  Prevention
of the the onset of a targeted condition by the use of primary preventive
measures is of great benefit for both the individual and the community
(Seballos, R., 2017). Health education by expert staff can in turn reduce the
demand on the limited health provisions available in rural and remote areas as
patients are more able to treat themselves for minor ailments (Duckett &
Willcox, 2015).  The use of more
technological advanced systems of providing healthcare allows for improvements
in productivity and reduces demand for health care.  Planning into skill mix and role extension in
order to meet the health needs of those living in rural and remote areas is a
required output for the future if a healthy workforce is to be maintained (Duckett
& Willcox, 2015).

In conclusion, a healthy system needs to change and adapt in
response to its environment and in response to outputs and the feedback on the
adequacy of its process (Duckett & Willcox, 2015). Aday (2004) suggested
that a health care system should be evaluated on three criteria; equity,
efficiency and effectiveness. For those living in rural and remote areas major
health inequalities still remain it would, therefore, appear inputs need to be
adapted to ensure outputs better meet the needs of this population and improved
outcomes are achieved.  This will require
targeted interventions for improvements (Frenk, 2010).