Inequities in rural health

Few issues go to the core of our very being as much as our personal health. It colours every aspect of our lives and makes other issues pale into insignificance.

But while the sentiment of not appreciating good health until you don't have it generally rings true, the one about "money can't buy health'' may not stack up so well.

Strictly speaking, money can't buy good health. But money does pay for insurance premiums that allow private medical care. It pays for dental health upon reaching adulthood. It pays for regular eye examinations, preventive immunisations, prescriptions and after-hours doctor's appointments. It also pays for warmer and better insulated homes, known to contribute to better health.

Officially, money may not buy good health. But it certainly doesn't do it any harm.

If you live in a rural area, there can be additional costs. In Central Otago, for example, those attending the after-hours GP clinic at Dunstan Hospital are charged $180 - for visits between 11pm and 8am; the fee is waived if the patient is subsequently admitted to hospital. Additional fees are charged for visitors to the area.

The absence of an accident and emergency department at Dunstan Hospital, and the need for residents to pay for after-hours care, has been a bone of contention for years in Central Otago, where residents wonder why they have to pay for services their urban counterparts get for free at city accident and emergency departments.

The same rural residents have often wondered why they had to pay for the fit-out of Dunstan Hospital in the first place; why all replacement equipment in the hospital still has to be paid for by the Central Otago community, to this day; and why Dunstan's CT scanner and scanner suite fit-out was also paid for by grants and the Central Otago community.

Nearby, in the Maniototo, residents gathered almost all of the money for their new hospital and rest-home, opened last month. Of the $7million cost, $1million came from the Labour-led Government (nothing was pledged by the previous National government). Hospital reserves, grants and community fundraising and donations have paid for the other $6million.

Funding struggles in the health sector are constant, but why are rural communities still having to pay for such significant capital expenditure in the health system? The inequity is hard to justify.

Some of the funds raised in small communities, in health and other sectors, comes from grants.

But it needs to be noted the Central Lakes Trust, the major contributor of grants in the Central Otago and Queenstown Lakes district, warned recently changes in government funding and legislation were straining social and emergency responses services to the point they were turning to the trust in order to survive.

It meant some of the "nice-to-haves'' might have to make way for more vital projects and funding, trust chairwoman Susan Finlay said.

About the same time, St John New Zealand asked the Minister of Health for more funding, saying the volunteer model of emergency care was no longer sustainable.

St John receives 72% of its funding from contracts with the Ministry of Health and Accident Compensation Corporation and the rest comes from emergency ambulance part charges and fundraising.

It is a nonsense that such a vital service as St John should have to be propped up by user-pay charges and fundraising, and an insult that rural communities have to pay more for healthcare than people in the city.

There is only a certain amount of taxpayer money to go around, and the Southern District Health Board's financial woes do not look like going away anytime soon.

But the St John funding and rural funding inequities need rectifying before the health of our population suffers and the fundraising capacity of small communities is exhausted.


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