Mind the $9 billion spending gap

The AMA has called for a nationally coordinated rural health workforce strategy that delivers sustained investment in training, infrastructure and services tailored to rural, regional and remote communities.

It comes as the latest National Rural Health Alliance (NRHA) spending report shows the health expenditure gap between rural and urban Australians widening.

Forgotten Health Spend: A Report on the Expenditure Deficit in Rural Australia 2026 found the gap had widened by a $880 million in the last three years.

The expenditure gap in 2023 sat at $6.55 billion, widening to $8.35 billion in 2025 and now $9.23 billion in 2026.

According to report each rural Australian is receiving, on average, $1218 less in healthcare funding each year than city residents.

Those living in small rural towns of 5000 people or less bear the greatest brunt of the systemic shortfall, receiving on average $6368 less healthcare funding per person, per year.

The AMA’s call for a rural health workforce strategy is part of the association’s revised Rural Workforce Initiatives 2026 position statement which proposes reforms spanning medical school entry, specialist training, workforce incentives and support for doctors and their families.

The statement calls for governments to establish robust, nationally coordinated health workforce planning functions, including transparent supply‑and‑demand modelling, long‑term strategy and public accountability.

It says such a strategy is needed to address "persistent rural workforce shortages."

Chair AMA (WA)'s Rural Doctors Group Dr Paddy Glackin told Medical Forum that responsibility for rural workforce issues had been palmed off for too long.

"We really need state governments and the Commonwealth, whether it's through a new body or existing bodies, to step up and take responsibility," he said.

"What we've seen for years is the states palming off general practices saying that primary care is not their concern and the Commonwealth saying small country hospitals aren't their concern.

"Nobody is stepping forward and it's rural communities that are suffering as a result."

The AMA wants to see a shift away from what it calls blunt location-based incentives, towards a graduated framework that reflects remoteness, community need and the complexity of rural medical practice.

Dr Glackin said WA communities would require context driven approaches.

"One thing that we know is that one size fits all approaches from the Commonwealth, which is what we currently have in general practice in particular, simply doesn't work.

"It breaks down when you get to places like remote and rural WA, so I think what we need is a workforce strategy that recognises differences and that empowers different models."

The AMA is calling for regional hospitals and practices to be recognised and resourced as core training hubs for both generalist and specialist pathways, with training positions distributed according to population need.

It also recommends flexible rural training options, including remote supervision, hybrid training models, regional access to examinations and flexible approaches to assessment.

AMA Vice President Associate Professor Julian Rait said a sustainable workforce starts with training.

“We know that students from rural backgrounds, and those who have had positive rural training experiences, are more likely to go on to practice in rural areas.

“Too often, a young doctor must move to the city to finish their training, and many never return.

“Rural doctors often carry heavy and complex workloads, including procedural work, on-call responsibilities, after-hours care and service continuity pressures. They should not have to choose between burning out and walking away.

 Attracting and retaining doctors means supporting their lives outside work, including access to affordable childcare, partner employment, education, accommodation and confidential wellbeing services.”

NRHA chief executive Susi Tegen said Australia faced a health equity crisis.

“Rural people are being let down by a universal health system that should support them when they need it most,” she said.

“The figures demonstrate the consistent under prioritisation and underfunding of rural Australians and clinicians that support them, despite their vital contribution to the Australian economy across various sectors.”

She said even matching city spending dollar-for-dollar wouldn’t close the gap, because care costs more to deliver in the bush.

The Forgotten Health Spend Report calls for sustainable, long-term solutions that are tailored to rural Australia.

Ms Tegen called for a holistic change to Medicare.

“Block and blended funding needs to be part of the solution for rural Australia. Bulk-billing alone is not sustainable long-term in these regions, as it is in the city, because of thin markets, leading to clinic closures and even further distances to necessary services,” she said.