Health Care Delivery in Port Macquarie: Growing Pains? Port Macquarie, a town situated on the Hastings River on the New South Wale mid-north coast, was once a smallish rural community whose economic lifeblood depended on the timber industry, agriculture and fishery, and later, tourism. However, in the last decade, the town’s population had grown significantly, fed mostly by retirees from Sydney, who brought along with them an ever-growing demand for health care services.
As a result, health care delivery in Port Macquarie is facing a dilemma. The problem- a lack of health resources- is essentially the same one that is facing all of rural Australia, but is especially significant here given the town’s continual dedication to further growth, particularly in the aged sector. This report aims to explore the shortfall of rural health resources, the growing need for more sophisticated health resources of a large and expanding rural center, and the economic issues surrounding this dilemma.
The first impression that one makes of Port Macquarie is that it’s neither rural nor urban, but rather, is in a state of transition. This change is apparent wherever one looks- new housing subdivisions springing up in the outskirts of town, brand-new low-rise apartment buildings lining waterfront streets, and the busy local shopping mall is identical to any one found in suburban Sydney.
Port Macquarie is in the midst of a population boom, recording a three percent per annum growth rate since 1991 . This growth is driven mostly by retirees from Sydney, moving north in the search for a quieter seaside lifestyle . And this net migration is none the more obvious in the local GP’s surgery- most of the patients there are either retired or elderly. Such growth brings with it a familiar problem: the need for more resources, most notably in the area of health, since it’s the older part of the population who suffered the majority of chronic illnesses, who have the greatest need for preventative medicine and health screening.
However, Port Macquarie is still classified and view politically as a rural town, and despite its ever-expanding population, health care resources remain scarce- even though, on casual observation, this does not seem so. After all, Port Macquarie possessed not one, but several pathology services that will perform most of the investigations available in an urban area. However, these pathologists don’t only service Port Macquarie itself, but also surrounding smaller towns, and so, although available, they are stretched to the limit of their capacity. As a result, the Port Macquarie GP will only order a pathology assay only when it is truly indicated- unlike the urban GP’s, where “routine blanket” assays appear to be the norm.
The same problem exists for specialist referrals. Although Port Macquarie boasts a new Base Hospital, and despite many recent new appointments, the accessibility of consultant medical officers remains poor. The local GP need to call the hospital to ensure that a specialist is available before referring a patient- even for a common specialty such as cardiology. This is a significant problem, given that one-quarter of the population is over sixty-five , many of whom suffer from cardiovascular illnesses.
Cancer treatment facilities is also lacking, with patients needing to travel south to Newcastle for radiotherapy- a cost which must be borne out of their retirement savings. Subspecialties such as dermatology attract a waiting list that is at least two months long, and mental health services, while nominally available from the Base Hospital, is desperately short of expertise in dealing with youth depression and suicide- which is unfortunately too prevalent in rural areas, due to the lack of educational and employment opportunities . All of this meant that the delivery of health services burdens heavily upon the GP, who may not have the skills, or the time, to deliver such treatment.
Accessibility for allied health services, such as physiotherapy, is also limited- and again, this is a serious issue. The population growth in Port Macquarie meant that construction is fast becoming a major industry - and that brings along with it its share of work-related musculoskeletal injuries. This lack of treatment resources impacts significantly on patients’ lives and their ability to work, and associated with that, their economic status and quality of life.
All these problems were much worse previously. Prior to 1994, the only provider of secondary medical care was the government-run, poorly financed and technology-starved Hastings District Hospital . Fortunately, this defunct establishment is now replaced by the privately owned and operated Port Macquarie Base Hospital, albeit amongst much controversy and criticism as “Americanization” of Australia’s medical system.
Now, seven years on, a high level of health care is finally possible in Port Macquarie, providing much-needed diagnostic and treatment services- although the availability of these services are still limited, and like many rural areas, it is still the GP’s who are responsible for the majority of the local residents’ medical needs. However, the local government does recognize these shortfalls, and is committed to expanding local health services according to need.
The situation in Port Macquarie highlights the desperate need for health resources across all of rural Australia, and especially in growing retirement communities in coastal towns. Whilst the local GP’s are utilizing what resources they have as efficiently as possible, they cannot provide the sophisticated diagnostic and treatment facilities that an ageing population requires. And given the continued rationing of public health care funding in Australia, the shortfall in these facilities is likely to worsen instead of improve. There is no simple, ideal solution to this continuing dilemma- however, a study of health care delivery in Port Macquarie does suggest one thing- that perhaps a privately operated health care facility, with the government providing funding as fee-for-service, may be a financially viable option.
1. Hastings Council. Hastings Community Profile 1998. 2. Hastings Council. State of the Environment Report 1999-2000.