That's the grim scenario set out by new figures released by the National Rural Health Alliance, showing those who live outside the cities miss out on $1090 in health spending per person every year.
The Forgotten Health Spend report, released on Monday, showed the gap between metropolitan and rural health expenditure has widened since 2023, when the annual deficit was $6.55 billion or roughly $850 per person per year.
The gap was driven by public and private hospitals, Medicare billing, dentistry and allied healthcare and was directly responsible for long wait times, specialist shortages and ageing health infrastructure, the report said.
Alliance chief executive Susi Tegen said the healthcare gap failed to recognise rural Australia’s economic contribution across mining, agriculture and tourism.
“There are 7.3 million people bringing in two-thirds of Australia’s export income ... and producing 90 per cent of the nation’s food, and we’re starving them,” Ms Tegen told AAP.
“There is a total disregard and disrespect for rural people and the value they bring — they have every right to have the same health expenditure.”
The spending shortfall has been prolonged, leading to entrenched disadvantage and poorer health outcomes, Ms Tegan said.
Avoidable deaths in the bush are nearly four times higher than in metropolitan regions, with life expectancy up to 13 years shorter for people in very remote areas, according to the alliance’s rural health snapshot.
The latest financial modelling, by consultancy group Nous, showed people in towns with populations between 2000 and 10,000 got half the health expenditure of city residents.
Many small towns have been forced to do their own fundraising for community-run health centres, including in Mareeba, in far north Queensland, and the Bogan Shire, in western NSW.
“They’ve paid their taxes, they’ve paid their Medicare levy and they’re still having to raise funding from that same community,” Ms Tegen said.
“Can you imagine somebody in (Sydney’s) Woollahra or (Melbourne’s) Toorak doing that?”
Australian College of Rural and Remote Medicine president Rod Martin said the spending shortfall could no longer be ignored.
“It’s leading to higher rates of hospitalisations, chronic disease, and premature and preventable death,” Dr Martin said in a statement.
Better investment in training for rural generalists, who were GPs with extra specialist skills, was key to addressing inequity, he said.
The Federal Government’s 2025-26 budget set aside more than $265 million for extra GP and rural generalist training places, along with rural workforce incentives and more Medicare Urgent Care clinics in rural areas.
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