Why is this useful for rural and remote people?

Health policies are intended to result in an improvement in health outcomes for people. Policies can be direct, for example a policy to ban advertising to reduce smoking, or indirect for example a policy to increase the rural medical workforce to ensure rural people have good access to primary care. It is therefore important to understand whether health policies actually lead to improvements that contribute to better health in rural and remote communities. We know for example that rural medical workforce policies have failed to reverse the decline in the general practice workforce in rural areas, and have resulted in significant growth of doctors in cities, yet the policies remain largely unchallenged despite this failure. This paper looks specifically at the issue of privatisation of health services, which includes activities such as the outsourcing the operation of public hospitals to private operators. To the extent that privatisation policies were argued to be essential to improve the cost-effectiveness of the delivery of health care, and reduce health inequity, in Europe it is relevant to ask “did it work”. This study found that privatisation policies largely failed to improve health outcomes, address unmet need or reduce inequity. The report notes that there is a need to “understand the workings of the political process as pathways and mechanism through which power configurations cause illness and inequity (see Lynch 2023)”. In short, policy decisions such as the privatisation of health services are often represented by health systems as neutral decisions referencing economic theories or other rational justifications. Yet, the evidence suggests that these policies are innately political in nature, and that the political process provides opportunities for actors to lobby for their own interests behind the scenes. The authors argue that “health policy” decisions should therefore properly “be brought into the political arena and that policy interventions, especially controversial ones such as privatisation, [should be subject to] extensive [public] debates before they are implemented.” Rural and remote people are often told that policies are based on extensive research and evidence. What this study suggests is that the selection of evidence, or privileging of vested interests, can result in health policies that are poorly aligned to community need, and that thee decisions should therefore be part of the public political debate rather than decided behind closed doors. For rural and remote people, given the consistent failure of rural health policies to improve access to health care, or community health outcomes, it may mean that rural health policies should be decided by the public, and subject to more rigorous public debate before adoption.