Telehealth is a powerful tool in the fight against health inequality. It enables precious healthcare resources to be distributed across vast distances and reduces the burden on patients and the heath system.
As we mark Telehealth Awareness Month, we have an opportunity to explore the immense transformative potential embedded within telehealth. This innovative technology can reconfigure and break down the substantial structural obstacles that persistently fuel health inequality across our wide, brown, land.
In global terms, Australia boasts a higher per capita count of doctors than many countries, with 37% more than Canada, 29% more than the USA, and 24% more than the UK, as per the World Health Organization. Yet, despite this abundance, health care access remains unevenly spread across our continent.
According to the Department of Health and Aged Care, Australians in very remote areas have access to 45% less primary health care than their urban counterparts. Research from the Royal Flying Doctor Service (RFDS), shows this leads to females in very remote areas dying 19 years earlier than those in major cities. For males the gap is 13.9 years. Moreover, both sexes in remote areas face a mortality rate 1.5 times higher than that of urban dwellers.
Even in densely populated Victoria, where nearly a quarter of the population lives in rural and regional areas, health inequality remains a pressing concern. Rural Victorians experience inferior health outcomes when compared to their metropolitan cousins. The statistics are telling – cancer rates are 28% higher outside of Melbourne, chronic obstructive pulmonary disease (COPD) is 50% more prevalent, pneumonia and influenza afflict 39% more individuals, congestive cardiac failure is 17% more common, and the list goes on.
It’s not that rural Australians are innately unhealthier, it’s that they face systemic issues that their city cousins don’t. Where I live in Melbourne, there are around 40 GPs spread across five clinics within a five-minute drive of my house. However, the tyranny of distance and the smaller populations can mean a very different story outside of the capital cities.
Once such example is Ed, a resident of the Mallee and the local bus driver. Ed needs regular checkups with an endocrinologist to maintain his driver’s license. A trip to see his endocrinologist in Melbourne would require a nine hour round trip, generally requiring an overnight stay to remain safe with his travels.
However, for the last four years Ed has used the Flying Doctor Remote Specialist service from his local health service, some 15 minutes from home. In doing so, he meets with the local diabetes nurse educator in person and follows it up with a quick telehealth appointment with our endocrinologist, all accomplished within an hour.
By partnering with the local health service, Flying Doctor Remote Specialist gives patients like Ed the best of in-person and virtual care. By using telehealth in this way, Ed receives invaluable health literacy training from the local diabetes nurse educator in conjunction with the specialist endocrinologist.
Another important consideration is digital inclusion. As Ed says, “Out here we’re lucky to get internet service, because of where we are. On the tech side of it… I’m not technical at all, but here I walk in, and it’s all set up.”
Digital inclusion
The most recent Australian Digital Inclusion Index tells us that while there’s a gradual overall improvement in digital inclusion across the nation, it remains disproportionately distributed. Notably, First Nations people in remote and very remote areas, individuals aged over 75, and those in the lowest income quintile all fall significantly below the national average in terms of digital inclusion. While part of this disparity is attributed to limited access, another crucial factor is digital literacy.
Flying Doctor Remote Specialist sees the digital literacy problem daily given that 46% of our patients are over the age of 55. As such it’s not uncommon for our team to spend half an hour or more on the phone with a patient before an appointment helping them come to terms with the technology that so many of us take for granted. A common question the team ask of patients is “does your phone have a camera?” This commitment to patient care, and the greater level of support required by many patients in the bush, can make it hard for the service to cover its costs from bulk-billing Medicare alone.
Telehealth represents a wise investment. Our average telehealth appointment gap is $124, which is fortunately covered by our generous donors. Whereas a day in the hospital is now between $5,000 – $6,000 dependent upon where you live in Australia. Using telehealth to keep people like Ed out of hospital is a great investment, saving taxpayers in the long run because it gives everyone equal access to world class care.
Telehealth not only removes the structural limitations imposed by geographical distance to patients, but also offers flexibility to clinicians. Attracting clinicians to live and work in regional locations is a global challenge. With telehealth clinicians can live where they want and work there’s greatest need. At RFDS Victoria, our clinicians live in Sydney, Canberra, Melbourne and everywhere in between. Nevertheless, all of them are working in the regions without having the burden of travel.
It’s for these very reasons that telehealth transforms health care into an instrument of a fair go. It gives freedom to clinicians who can choose where they live without shouldering guilt. It empowers patients to live where they desire without facing early mortality. It enables working individuals to prioritise their health without sacrificing their livelihoods.
For those of us who have the privilege to work in a telehealth service, we must embrace an even greater responsibility in using this platform to dismantle the systemic barriers that perpetuate health inequality. No longer should the tyranny of distance dictate the quality of health care one receives. With telehealth, distance is set free, and so too are the prospects for health equality.
In conclusion, telehealth is more than a technological advancement in health care; it’s a tool for justice, equity, and ultimately, better health outcomes for all Australians. When Telehealth Awareness Month ends, we must continue to seize this opportunity to bridge the chasm of health inequality and ensure that good health is a right, not a privilege, for every citizen.
Chris De Sair is the Digital Health Services Manager for the Royal Flying Doctor Service Victoria.
Great insights into the challenges of fair and equitable access to healthcare, thanks for sharing! It was how we approached it before the pandemic and we need to get back to this. Seeing as it saves so much money compared to in-person, maybe telehealth reimbursements should be higher for rural and remote patients where in-person is not available, to make up for the needs for extra support.