There are obvious and well-understood reasons why rural Australians often receive poorer health care than those in the cities: a shortage of health professionals, longer waiting times, a lack of health infrastructure, and the tyranny of distance.
These may be explanations, but they should not be used as excuses. Avoidable catastrophic failures in regional hospitals are sadly common: Graeme Reeves, the so-called Butcher of Bega; Emil Gayed in NSW, Jayant Patel in Bundaberg, the appalling births crisis in Bacchus Marsh, Victoria.
The sad fact is many of this country's medical scandals disproportionately occur in the regions, as this week's ABC Four Corners program so devastatingly documented.
Rural emergency departments are too often staffed by GPs and not specialists. Services such as radiology are often simply not offered and understaffing is a chronic problem. Maternity, mental health, oncology and surgery are areas of particular concern. But these problems can be solved with the right mix of policies and funding.
Workforce infrastructure is a critical issue. Building a facility is pointless if you can't staff it appropriately. We see this in many areas where there's a hospital and an ED, but it's being staffed by local GPs, rather than ED specialists.
Regional hospitals can struggle to attract specialists, but this isn't only because of remuneration. It's also related to training and opportunity. We need to find ways to attract senior medical leaders and administrators to regional Australia. The people who run hospitals and health services generally set the standards, set the culture.
A good example is the Bacchus Marsh maternity scandal: a failure of leadership affected the entire hospital with catastrophic consequences. We also have to ensure the quality of healthcare in rural areas matches metro areas - a two-tier system is unacceptable. Unfortunately, previous policy interventions arguably undermined quality and safety. For example, there were less restrictive qualification requirements for internationally trained medicos who practised in rural areas. In 2013, the Medical Board reviewed these doctors and introduced standardised testing. The result? In 2018, 4 out of 5 of failed. So how do we solve this?
We need targeted and coherent government intervention at all levels. We can't just leave it for the regional health services to work out. And importantly, questions have to be asked of the medical and surgical colleges. They also have a role to play.
Tom Ballantyne is a medical negligence lawyer and principal with Maurice Blackburn lawyers