Introduction
Australia has a geographically tiered health system which is reinforced by a long-term pattern of urban-centric policymaking. As a result, people living in rural and remote areas have poor health outcomes, a high rate of preventable hospitalisations, and premature death. Virtual healthcare has been proposed as a strategy for improving geographical health equity, but many clinicians and health service leaders consider telehealth and virtual healthcare to be substandard compared with traditional face-to-face delivery. It is important to ensure that new services for people in rural and remote areas are designed and delivered to the same standard as traditional health services in metropolitan areas.
Methods
This was a qualitative thematic study with a focus on identification of hidden meaning representing unconscious bias. Interviews were conducted with clinicians and health service leaders (February-July 2023, Queensland, Australia) to inform the design and delivery of a new private virtual hospital. Three rounds of analysis were conducted by three coders using reflexive practices.
Results
26 participants: 5 health service leaders, 3 clinicians, and 18 who were both a leader and clinician. Three themes were identified: 1) traditional face-to-face healthcare is better than telehealth; 2) virtual healthcare offers an opportunity for rural and remote residents with limited access to face-to-face healthcare; 3) telehealth is better than nothing. Theme three focused on participants’ acceptance of substandard healthcare when the alternative is no healthcare at all.
Discussion
Taken together, the three themes indicate a tacit acceptance of a lower standard of healthcare for people living in rural and remote areas. This reflects a known urban-centric bias of healthcare policy makers. If a lower standard is considered acceptable because it is ‘better than nothing’ this may negatively influence the design/ delivery of virtual healthcare services in rural and remote areas. This urban-centric bias must be addressed to ensure equitable access to appropriate health services and health outcome equivalency.