Who cares about the health of those who live outside the big cities? Not many gave two hoots during the election campaign, but suddenly rural health concerns are front and centre.

The Independents may be playing on the high moral ground, saying that stability of government is their overriding priority, but health is a critical issue for their rural electorates.

So if there is to be horse-trading on behalf of rural health, what should be the priorities, and can these be leveraged to also benefit the broader community?

Carol Bennett, executive director of the Consumers Health Forum, is optimistic that the Independents will appreciate the need for local communities to have a greater say in their health services.

“Unlike the doomsayers in the media predicting political chaos, those of us fighting for quality health reform can see many positives from the current uncertain political climate,” she says.

Bennett advises the Independents to push for consumer engagement in local health decision-making processes, and better dental health, mental health and primary health care services, as well as a National Broadband Network for telehealth.

Health policy analyst Jennifer Doggett says Australia may have a rare opportunity to achieve health workforce reforms and other measures that are usually blocked by the AMA and special interest groups.

She advises the Independents to find policies where the major parties would like to deliver but have failed to do so due to pressure from such interest groups.

“This is where, if the independents are smart, they can achieve real gains for both their local communities and the country as a whole,” she says.

“Under the guise of negotiating pressure, the majors can afford to annoy the special interest groups whose support they required in the lead up to the election. This can give them the freedom to pursue strategies that were seen as too politically risky this time last week.  It can also help Ministers loosen the purse strings for programs for which they previously have been denied funding by the party bean-counters.”

Doggett says a public dental service is an example of a policy that would not only benefit rural communities.

“It can be done,” she says. “It just needs adequate funding and the political will to annoy some dentists who fear that a public program will undermine the profitability of private dentistry.”

Doggett says health workforce reform is another key issue for rural health “which struggles to attract professionals from the city but which is prevented from adopting innovative workforce strategies due to rent-seeking practices from the AMA and other specialist groups”.

Doggett nominates independent Medicare-funded midwifery as important for rural and remote people, including for Indigenous communities where women want the choice of birthing in country.

Professor Lesley Barclay, head of the Northern Rivers University Department of Rural Health in northern NSW, agrees that local access to birthing services is a critical priority, but says that improving rural health is not only about having “more”, whether doctors, nurses or dollars, but is also about redesigning services.

The National Rural Health Alliance’s Gordon Gregory says improving rural health is about much more than health services, and includes the need for regional development and decentralisation policies.

Decentralisation, he adds, is not only about where physical infrastructure is built but also about the way policy decisions are made.  Gregory has plenty of examples of how current arrangements disempower local services.

“The small hospitals and health services of the far southwest of New South Wales receive their pre-ordered frozen food from Albury (delivered through an 8-hour round trip), and management of their health staff is based in Queanbeyan (5 hours) and North Sydney (8 hours),” he says.

“To get a cupboard fixed in the small local hospital, permission – and the tradesperson – come from the larger centre an hour away.

“On the ground in Deniliquin and Finley, the local health service managers know what needs to be done but are powerless to do very much about it.  Their patients with more serious conditions travel across the Murray to northern Victorian hospitals – and some of the inter-State remuneration for such treatments flows more slowly than the river itself.”

Gregory says that regardless of which party assumes government, the push for greater local control of both hospitals and primary care envisaged in the previous government’s health reform agenda must continue.

He says it may be significant that the three Independents are all experienced in State as well as Federal politics, “because there is no area of public policy in which the relationship between the Commonwealth and the States is more complex and more critical than in health.”