In Warburton, on the Ngaanyatjarra Lands well over a thousand kilometres east of Perth, a pregnant woman whose delivery turns complicated does not walk to a birthing suite down the road. She is flown out — sometimes with only hours' notice — to Kalgoorlie or on to Perth, leaving work, family and country behind for weeks. If a storm grounds the aircraft, the wait stretches longer. The same is true, in smaller ways, for the pensioner in Meekatharra who needs a cardiologist, or the teenager in Halls Creek who needs a mental health crisis team. None of this is a failure of any single hospital; it is the arithmetic of a state where the nearest tertiary hospital can be a thousand kilometres and a chartered flight away.
That arithmetic is not new — Western Australians have organised health care around distance since before Federation. What is a live policy question, decided and redecided in every state budget, is how a government spends the money and builds the workforce to close the gap geography opens up. This piece examines the record of the Cook Labor government, and the McGowan government it succeeded, on regional health: what has been built, what the primary record shows it has achieved, and where the promise of care that does not depend on your postcode still falls short.
What the government did: a statutory country health service, a bigger budget, and a bet on telehealth
Health care outside Perth is delivered by the WA Country Health Service (WACHS), a single statutory health service organised into seven regions — Kimberley, Pilbara, Midwest, Wheatbelt, Goldfields, South West and Great Southern — running on a "hub and spoke" model in which larger regional hospitals such as Kalgoorlie, Bunbury, Broome and Geraldton refer into a much larger network of small hospitals, nursing posts and community clinics. WACHS describes its own catchment as the largest single health-service jurisdiction by area in the world: more than 2.55 million square kilometres, serving an estimated country population of around 566,700 people (WA Country Health Service, Overview, and ABS Estimated Resident Population data cited by WACHS, 2023).
The Cook government's 2025-26 Budget put $14.2 billion (approx.) into health services statewide, layering a further $121 million (approx.) of additional regional health and mental health investment on top, including $19 million (approx.) to lift the Patient Assisted Travel Scheme (PATS) — the subsidy that helps country patients travel to treatment — to 40 cents per kilometre (Western Australia, Budget Paper No. 2, 2025-26 State Budget, Part 5: Health, May 2025). The government has also built out the Emergency Telehealth Service (ETS), a 24-hour videoconference link between emergency specialists in Perth and more than 90 small country hospitals and nursing posts, which had recorded close to 250,000 patient consultations in its first decade of operation (WA Country Health Service, Emergency Telehealth Service, 10-year milestone, 2022, approx.). Underpinning it is the WA Health Workforce Strategy 2034, the long-range plan for training and retaining country clinicians, and the state continues to fund Royal Flying Doctor Service (RFDS) Western Operations, which runs aeromedical bases at Jandakot, Meekatharra, Kalgoorlie, Port Hedland and Broome.
The strongest case
No government can shrink the state, and WA has built genuine infrastructure around the distance it cannot remove
Put the government's defence at its best, and much of it holds. A jurisdiction of 2.55 million square kilometres serving barely half a million people cannot economically support a full-service hospital within an hour of every town; no state government, of any party, has ever solved that arithmetic. Faced with that constraint, WA has built one of the more sophisticated distance-medicine systems in the world rather than simply accepting the gap. The Emergency Telehealth Service puts a specialist doctor, by video, into a nursing post that might otherwise have no doctor on site — a genuine, documented achievement, not a slogan. The Southern Inland Health Initiative, evaluated by WA Health, restored 24-hour emergency medical access to southern inland towns that previously had little or none, and was credited with a roughly 70 per cent improvement in GP retention at the four-year mark (WA Department of Health, Southern Inland Health Initiative, program evaluation, approx.). Budget commitments have also kept growing across successive years, not just in one pre-election cycle, and the 2025-26 increase to PATS — contested below — is at least a subsidy rate being revised upward rather than left frozen. Credit is due for building real capability, not just announcing it.
The evidence: what the primary record shows about the gap that remains
Three independent bodies of evidence — the state's own Auditor General, national health data collections, and the Productivity Commission's annual Report on Government Services (RoGS) — describe a system that has genuinely narrowed the acute, life-threatening edge of the distance problem while leaving the slower, chronic edge of it largely untouched.
The starkest single number is the life expectancy gap by remoteness. AIHW rural health reporting finds life expectancy in regional areas running roughly one to two years lower than in major cities, and up to around seven years lower in remote areas (AIHW, Rural and remote health, approx.). Layered on top is a separate, larger Aboriginal health gap: national life expectancy for First Nations Australians remains around eight to nine years below that of non-Indigenous Australians, and within that gap, Aboriginal and Torres Strait Islander people in remote and very remote areas live shorter lives again than those in major cities (ABS, Aboriginal and Torres Strait Islander life expectancy, 2020-2022, released 2024). Because a majority of WA's Aboriginal population lives outside Perth, that pattern lands with particular force in the Kimberley, Pilbara and Goldfields — the three WACHS regions with the largest Aboriginal populations.
Emergency and hospital access data point the same direction. Nationally, the Productivity Commission's Report on Government Services 2025 recorded that only 53.4 per cent of emergency department patients, across all triage categories, were treated and left within four hours in 2024-25 — the lowest proportion since the measure began, down from 74 per cent a decade earlier — while noting that access to timely emergency care continues to vary by remoteness, even where the most urgent, category-1 patients are generally seen on time everywhere, including in WA (Productivity Commission, Report on Government Services 2025, Part E, Section 12: Public Hospitals, January 2025). The state's own watchdog has flagged a more basic problem behind numbers like these: in November 2024 the WA Auditor General reported on the quality and utilisation of emergency department data across WA Health, finding weaknesses in how that data is captured and used that make it harder for the department, WACHS included, to know with confidence where its emergency capacity is actually failing (Office of the Auditor General Western Australia, Report 4: 2024-25, Quality and Utilisation of Emergency Department Data, 20 November 2024). A system cannot reliably target scarce rural resources if it cannot reliably measure where the queues are.
Workforce and travel: the two constraints telehealth cannot fix
Telehealth and the flying doctor service manage acute emergencies well precisely because they route around, rather than solve, the underlying shortage of clinicians willing to live and work in the bush. WACHS continues to lean heavily on fly-in fly-out locums and agency nursing to keep small-town emergency departments and maternity services staffed, a pattern the Southern Inland Health Initiative was designed to counter but which persists more broadly across WACHS's regions. And even where a patient reaches specialist care, PATS — even after the 2025-26 rise to 40 cents per kilometre — still reimburses well below the roughly 88 cents per kilometre the Australian Taxation Office treats as the real cost of running a car, before a family has paid for meals, accommodation or lost income on a multi-day round trip to Perth (Australian Journal of Rural Health, "The urgent need for equity in patient assisted travel schemes," 2024, approx.; WA Country Health Service, PATS Handbook). For a low-income country family — disproportionately Aboriginal families in the Kimberley, Pilbara and Goldfields — every long trip to see a specialist carries a real out-of-pocket cost the subsidy was meant to remove.
The critique: acute care has improved; chronic and preventive care has not caught up
Judged against its own stated ambition — that where you live should not determine the health care you receive — the record is genuinely mixed, and that mixed record is itself the finding. The ETS and RFDS partnership are real achievements: a critically unwell patient in a remote nursing post today has access to a specialist doctor by video and, if needed, an aeromedical retrieval, in a way that did not exist a generation ago. But the life expectancy and chronic disease data show that saving an acutely sick patient is not the same as preventing them from becoming one. The remote life expectancy gap, and the deeper gap layered on top of it for Aboriginal Western Australians, is overwhelmingly driven by chronic conditions — cardiovascular disease, diabetes, kidney disease, mental illness — that require ongoing, trusted local relationships with a GP or nurse practitioner over years, not an emergency video link on the worst night of a patient's life. A hub-and-spoke model built around retrieval and referral is, by design, better at rescuing a crisis than preventing one.
The government's own watchdog has twice, in successive years, found the primary record does not yet support confidence that new spending is reliably converting into better outcomes. The November 2024 Auditor General finding on ED data quality means WACHS cannot fully demonstrate, from its own data, where regional emergency capacity is under the most strain. A June 2026 Auditor General report into the Infant, Child and Adolescent Mental Health System Transformation Program — spanning the Mental Health Commission, Child and Adolescent Health Service and WACHS — found the agencies involved could not yet demonstrate the program was achieving its intended outcomes for young people, despite the investment already made (Office of the Auditor General Western Australia, Report 19: 2025-26, 17 June 2026). Two audits, eighteen months apart, reaching a similar conclusion — that spending moved faster than the evidence of its effect — is a pattern a government committed to evidence-based regional health should be closing, not repeating.
PATS is the clearest example of a policy that looks generous in a press release and still falls short on the ground. Lifting the subsidy to 40 cents per kilometre is a real increase, and the government is right to point to it. But set against the ATO's own benchmark for the cost of running a car, the subsidy still covers under half the real cost of a trip, before a family has paid for a motel room in Perth or lost a week's wages beside a hospital bed. A subsidy pitched well below the real cost of travel functions, in practice, as a geography tax on the very families — often Aboriginal, often low-income, often carrying the state's worst chronic-disease burden — the scheme exists to help.
Western Australia has built a genuinely capable system for evacuating the sick from the bush. It has not yet built one that keeps them well enough to stay there.
The risk to the future
An ageing, growing bush outrunning a workforce pipeline no state fully controls
The country population WACHS serves is ageing at the same time as it is growing in the resource regions, and both trends raise chronic-disease demand faster than a locum-dependent workforce model can absorb. Australia's broader shortfall in GPs and rural clinicians — a national pipeline problem no single state can solve alone — lands hardest in the towns furthest from Perth, where WACHS must compete with every other regional health service in the country for the same shrinking pool of doctors and nurses willing to relocate. A workforce built on fly-in fly-out locums is also a standing cost pressure that never converts into the trusted local relationship that actually prevents chronic disease, meaning WA can keep paying more each year without the underlying gap closing.
Climate adds a second pressure the current model was not built to absorb: more extreme heat and more frequent cyclone disruption in the Kimberley and Pilbara mean more, not fewer, calls on an RFDS and ETS network already near capacity. If the acute-care gains of the past decade are not matched by equivalent, sustained investment in local, permanent primary care, the risk is a state that keeps getting better at rescuing remote Western Australians from health crises while the gap that produces those crises — and the life-expectancy shortfall that is its clearest measure — remains as wide a generation from now as it is today.