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Bonded Medical Program: A Policy that Can Close the Gap in Healthcare

Affordable accessible healthcare has been marked as an essential human right by the World Health Organization (Fisher et al., 2016). However, health equity remains to be a major issue in the Australian healthcare system (AIHW, 2018). This gap has been evidenced largely through the access of the healthcare services in the rural and the urban regions of the country and also by the extreme difference between the life expectancy of the Australian population livening in the urban and rural areas (Government of Australia, 2019).

To minimize this gap, several policies like “closing the gap” and initiatives like “Bonded Medical Programs” have been developed that target the remote areas to minimize this prevalent inequity. This essay aims to address the aforementioned health problem of inequity and identifies the key stakeholders that can play a role in minimizing the gap. Further, this essay will also signify the need for bonded medical programs in Australian healthcare and highlight how they can help in minimizing the identified problem.

The Australian healthcare system has been embarked as one of the most successful healthcare systems globally. However, the healthcare system has been also associated with an impending challenge of health equity in the country (AIHW, 2018). The social determinants of health like income, education, environment, etc, significantly impact the health of the population. The health inequity in the country is largely associated with the socio-economic position of the indigenous population of the country (Fisher et al., 2016). The low-income levels of people in rural areas have been intricately linked with access to the healthcare services of the country.

Population residing in remote locations struggle to get adequate healthcare facilities and therefore are more likely to develop the disease and have higher morbidity rates. Further, inequity in the population also arises due to existing stigmas and prejudices in the society associated with the indigenous culture which is developing reluctance in the community to access healthcare services (Baum et al., 2018). The existence of health inequality in the system can also be evidenced by the significant difference in the average life expectancy of the country in contrast to the life expectancy of the indigenous population. Even when the life expectancy in Australia is about 82.5 years, for the indigenous population it is way below with a major difference of about 9 years.

The Government of Australia (2019) reports that in the year 2015-2017 the life expectancy in both males and females were reduced as the remoteness increased. Further, in the year 2017-2018, preventable hospitalizations rates in the remote areas were 2.5 times higher as compared to the major cities (AIHW, 2018). The urgent need of more rigorous applications of the policies towards rural healthcare of Australia is also marked by the fact that in the year 2015, the reported burden of diseases in the remote and rural areas was 1.4 times higher than that of the major cities (Government of Australia, 2019).

This staggering difference is large because due to inadequate access to the healthcare services, evidenced by the fact that in 2016, it was reported that people in remote areas are more likely to report barriers in accessing the healthcare services to reach the general physicians and specialists than the people in major cities. It, therefore, becomes an essential responsibility of the healthcare workers and community nurses to advocate for the primary rights of the rural and indigenous communities to help improve healthcare (Delany et al., 2016).

The primary role players that can play in limiting the gap are the public and community healthcare workers, private healthcare workers, and the government. The community healthcare workers form the first line of contact with the people (Herd et al., 2017). Therefore, it becomes their essential responsibility to reach the population in the remote localities and help in bridging the gap. It also becomes crucial for the government to bring in effective schemes and monitor their application to limit this health inequity in the population and to assist with the required funding. However, the essential stakeholders in the Bonded Medical Program are also the medical universities that must foster and promote their final year students to go and work in remote locations to minimize the health gaps.

The private medical institutions must also help in this initiative by taking responsibility and expanding their resources in remote areas. This can be done by assisting through funding or by the allocation of the resources to the nurses and healthcare workers that participate in the programs like Bonded Medical Program (Government of Australia, 2020). Other significant roles can be played by the pharmaceutical industries and insurance companies to facilitate the availability and accessibility of healthcare services in the rural and remote areas of Australia.

The Bonded Medical Programs is an initiative of the Government of Australia that allows the healthcare workers to provide healthcare services in the bound regions or remote localities that have a lack of healthcare service facility. The original program was launched in the year 2001 and has been updated in 2020 with the BRoSS (Bonded Return Service System) and is being applied in the different phases in Australia (Government of Australia, 2020). The program provides Commonwealth Supported Places to the medical students for medical internships and to promote healthcare in the remote and the rural areas (Government of Australia, 2020). By providing the essential workforce in the rural areas, where the access to the health facilities are limited, health promotion programs and community health beneficence can be carried out by the medical students in their course of the internship.

This will help in educating the rural community and provide them access to healthcare services. It will also help in minimizing the inequities in the rural community as the care services will be more easily available and accessible (Playford et al., 2017). Implementation of this policy successfully can, therefore, be seen as a foundational policy that will help in connecting the rural and remote populations to the healthcare services and minimize the disparity. Beyond this, it will also give the young healthcare professionals a chance to explore different communities and understand the impact of social determinants on health that will help in impressments of their current and future services (Puddey et al., 2017).

This essay provides a concise discussion of the need for policies that can help in the minimization of the prevailing gap associated with equity in the healthcare system of Australia. This paper summarizes how even the highly developed healthcare system of Australia is struggling to meet the inequity in its healthcare. The lack of availability and access to the poor health of the remote and rural population is largely impacted by the social determinants that shape the community health. It has also been reported that access to healthcare services is limited in these regions impacting the overall wellbeing and health of the communities that live there.

This paper highlights how policies like Bonded Medical Programs can help in the closing of this gap by serving as a means to reach out to the rural population via trained medical students to minimize this disparity. This essay also identifies the key stakeholders that can play role in the minimization of inequity in access to healthcare and identifies that public and private hospitals, medical universities, pharmacies, and healthcare professionals can together drive this change and promote health.

References

AIHW (2018). Australia’s Health in brief. Retrieved from: https://www.aihw.gov.au/reports/australias-health/australias-health-2018-in-brief/contents/all-is-not-equal

Baum, F., Delany-Crowe, T., Fisher, M., MacDougall, C., Harris, P., McDermott, D., & Marinova, D. (2018). Qualitative protocol for understanding the contribution of Australian policy in the urban planning, justice, energy and environment sectors to promoting health and health equity. BMJ Open, 8(9), 025358.

Delany, T., Lawless, A., Baum, F., Popay, J., Jones, L., McDermott, D., ... & Marmot, M. (2016). Health in All Policies in South Australia: What has supported early implementation?. Health Promotion International, 31(4), 888-898.

Fisher, M., Baum, F. E., MacDougall, C., Newman, L., & McDermott, D. (2016). To what extent do Australian health policy documents address social determinants of health and health equity?. Journal of Social Policy, 45(3), 545-564.

Government of Australia (2019). Rural and remote health. Retrieved from: https://www.aihw.gov.au/reports/rural-health/rural-remote-health/contents/rural-health

Government of Australia (2020). The Bonded Medical Program new arrangement. Retrieved from: https://www1.health.gov.au/internet/main/publishing.nsf/Content/reformed-bonded-programs

Herd, M. S., Bulsara, M. K., Jones, M. P., & Mak, D. B. (2017). Preferred practice location at medical school commencement strongly determines graduates' rural preferences and work locations. Australian Journal of Rural Health, 25(1), 15-21.

Playford, D., Ngo, H., Gupta, S., & Puddey, I. B. (2017). Opting for rural practice: The influence of medical student origin, intention and immersion experience. Medical Journal of Australia, 207(4), 154-158.

Puddey, I. B., Playford, D. E., & Mercer, A. (2017). Impact of medical student origins on the likelihood of ultimately practicing in areas of low vs high socio-economic status. BMC Medical Education, 17(1), 1.

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