Pulse ·
$9.23 billion: the growing gap in what rural Australia gets from healthcare
A new National Rural Health Alliance analysis finds a $9.23 billion annual gap in healthcare spending between rural and urban Australians — $1,218 per person — and the gap grew by $138 in the past year.
The main drivers are falling private hospital spending and declining rural private hospital viability. Medicare-funded general practice contributes $199 per person to the gap. In the most remote areas, per-person MBS spending is roughly half that of major cities.
Telehealth has not offset the reduced access to MBS-funded services in remote areas; use of telehealth falls as remoteness increases, which challenges the assumption that digital health has solved rural access inequity.
If you live outside a capital city and have ever driven three hours for a specialist appointment, waited weeks for an ECG in your town, or been told over the phone that your symptoms are “probably nothing” — you already know this. But sometimes it helps to see the number.
$9.23 billion per year.
That is the healthcare spending gap between rural and urban Australians, according to the latest analysis by the National Rural Health Alliance (NRHA), conducted by management consultancy Nous Group. Published this week, it covers the 2024–25 financial year. Per person, the gap is $1,218 — and it grew by $138 in real terms in the past year.
This is not a new story. The NRHA has published this analysis annually since 2023. What is notable about the 2026 figures is the direction: the gap is still widening, despite sustained political attention to rural health, and despite the telehealth expansion that was supposed to be a levelling-up technology.
The telehealth finding is the most important number in this report
Telehealth became the default policy response to rural health access gaps. It is cheaper to deliver than outreach clinics, politically easier than rural workforce reform, and scalable without requiring a new GP to move to Broken Hill. Successive governments have pointed to telehealth uptake as evidence that access inequity is narrowing.
The NRHA analysis finds the opposite. Telehealth use falls as remoteness increases. Not rises — falls. And the drop in telehealth uptake tracks the drop in MBS-funded services in remote areas overall, suggesting that telehealth is not reaching the populations most underserved by in-person care.
The reasons are not hard to understand once you account for what telehealth assumes: reliable broadband, a device with adequate screen quality for a clinical consultation, health literacy to navigate a video platform, and — critically — a presentation whose management does not require physical examination. Those assumptions hold less reliably in Modified Monash Model 5–7 communities than in inner-city suburbs. Telehealth is not a universal access equaliser. It is an access equaliser for the patients who were already closest to equitable access.
Both-and: the data and the response
The NRHA is calling for a national rural and remote health strategy — a framework document that defines what level of access rural Australians should be able to expect, and against which progress can be measured. Associate Professor Michael Clements, RACGP Rural Chair, broadly supports this but is explicit that the strategy cannot be a reason to delay action. “Politicians need to be confronted with that data,” he told newsGP, and he is clear that he does not want to wait for a strategy document before resources start moving.
The practical response Clements favours is scaling what already works: Primary Health Networks that have used flexible funding to build community-responsive models, council-supported local health services, and workforce incentives targeted at specific community needs rather than blanket national schemes.
The both-and here is genuine. A national strategy is a necessary thing to have — naming the target is the only way to measure progress. And: strategies are documents, not services. What rural patients need is more GPs, more specialist outreach, better-resourced allied health, and a funding model that does not default to city-based benchmarks for a population that cannot access city-based care.
The MBS contribution to the gap — $199 per person — is the lever general practice can most directly influence. An MMM 7 community receives approximately $811 per person in MBS spending against a metropolitan $1,535. That is a 53% shortfall. It reflects not only fewer GPs but also fewer people claiming rebates for services they are not receiving, because services they are entitled to do not exist near them.
2 cents
If you are a patient outside a major city: the gap is real, documented, and widening. It is not a perception or a sensitivity. If you have been getting less care than an urban patient with the same condition, that is probable rather than paranoid.
Practically, this means a few things worth knowing. Bulk-billed telehealth remains accessible in many settings even where in-person services are scarce — the access gap does not mean telehealth is useless, only that it cannot be the sole response. Primary Health Networks operating in your region may fund allied health, specialist outreach, or community health services that are not well publicised. It is worth asking your GP what PHN-funded services are available in your community.
If you are a GP working rurally or considering it: the spending data is a mirror for what you already know on the ground. The system gap is structural, but the individual consultations you run in a community that would otherwise have none are doing precisely the work these figures reveal is missing.
Verdict: maybe — the data matters; structural change is slow and needs sustained pressure.
Sources cited
Frequently asked questions
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How much less do rural Australians receive in healthcare spending compared to city residents?
According to the 2026 NRHA analysis, rural and remote Australians receive $1,218 less per person per year in total healthcare spending than urban Australians. In the most remote areas (MMM 7), MBS spending per person is approximately $811, compared with $1,535 in major cities.
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Has telehealth helped close the rural health gap?
No — the NRHA analysis found that telehealth use decreases as remoteness increases, and telehealth has not offset the reduction in MBS-funded services in remote areas. This challenges a common assumption that digital health access has solved rural health inequity.