Country, Culture and the Cost of Care: The Burdens Behind the Journey for Health
1
Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
2
E.M.U Consultancy, Ceduna, Australia
3
Commonwealth Scientific Industrial Research Organisation, Brisbane, Australia
4
The George Institute for Global Health, Newtown, Australia
5
School of Population Health, University of New South Wales, Sydney, Australia
6
Wardliparingga, South Australian Health and Medical Research Institute, Adelaide, Australia
7
School of Medicine, College of Health, Adelaide University, Adelaide, Australia
8
Rural and Remote Health, Collage of Medicine and Public Health, Flinders University, Darwin, Australia
9
Royal Darwin Hospital, Darwin, Australia
10
College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
11
Caring Futures Institute, Flinders University, Adelaide, Australia
12
College of Medicine and Dentistry, James Cook University, Townsville, Australia
13
School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
Popul. Med. 2026;8(Supplement Supplement 1):A1923
ABSTRACT
BACKGROUND:
Australians living in rural and remote areas face a disproportionate burden of out-of-pocket healthcare expenditure (OOPHE) due to limited local services, long travel distances, and higher indirect costs. These pressures force families to choose between essential needs and accessing medical care, often leading to delayed or foregone treatment. For Aboriginal people, the impacts are intensified by chronic disease inequities, structural barriers, and the cultural strain of travelling off Country for healthcare. We aimed to understand the impact of OOPHE on Aboriginal people living in remote South Australia and explore the cultural implications of leaving Country for treatment.
METHODS:
Guided by an Aboriginal Governance Group, we conducted a community-led qualitative study using the Indigenous research method of yarning with Aboriginal adults who had personal or family experience travelling for healthcare. Yarning sessions were thematically analysed in NVivo using deep listening for contextualisation.
RESULTS:
Across 16 participants’ lived experiences, findings showed persistent challenges in accessing appropriate local healthcare, resulting in frequent travel for essential care. Participants described substantial financial, logistical, cultural, and psychological burdens associated with travel, alongside limited knowledge of and support in navigating assistance schemes. These pressures contributed to delayed or avoided care, worsening health, cultural disconnection, and heightened stress. Despite these barriers, strong family networks, pooled resources, and connection to Country emerged as key protective factors helping individuals manage these demands. These themes are illustrated through three narrative stories.
CONCLUSIONS:
For remote Aboriginal communities, the burden of OOPHE is clear, but its long-term impacts extend into daily life, creating cycles of delayed care, cultural disruption, and poorer health outcomes. Reducing OOPHE requires Aboriginal-led solutions, including investment in local or visiting services, culturally safe navigation and liaison roles, streamlined advance payment support schemes, family-inclusive travel and accommodation supports, flexible scheduling, and on Country models of care co-designed with communities.
Australians living in rural and remote areas face a disproportionate burden of out-of-pocket healthcare expenditure (OOPHE) due to limited local services, long travel distances, and higher indirect costs. These pressures force families to choose between essential needs and accessing medical care, often leading to delayed or foregone treatment. For Aboriginal people, the impacts are intensified by chronic disease inequities, structural barriers, and the cultural strain of travelling off Country for healthcare. We aimed to understand the impact of OOPHE on Aboriginal people living in remote South Australia and explore the cultural implications of leaving Country for treatment.
METHODS:
Guided by an Aboriginal Governance Group, we conducted a community-led qualitative study using the Indigenous research method of yarning with Aboriginal adults who had personal or family experience travelling for healthcare. Yarning sessions were thematically analysed in NVivo using deep listening for contextualisation.
RESULTS:
Across 16 participants’ lived experiences, findings showed persistent challenges in accessing appropriate local healthcare, resulting in frequent travel for essential care. Participants described substantial financial, logistical, cultural, and psychological burdens associated with travel, alongside limited knowledge of and support in navigating assistance schemes. These pressures contributed to delayed or avoided care, worsening health, cultural disconnection, and heightened stress. Despite these barriers, strong family networks, pooled resources, and connection to Country emerged as key protective factors helping individuals manage these demands. These themes are illustrated through three narrative stories.
CONCLUSIONS:
For remote Aboriginal communities, the burden of OOPHE is clear, but its long-term impacts extend into daily life, creating cycles of delayed care, cultural disruption, and poorer health outcomes. Reducing OOPHE requires Aboriginal-led solutions, including investment in local or visiting services, culturally safe navigation and liaison roles, streamlined advance payment support schemes, family-inclusive travel and accommodation supports, flexible scheduling, and on Country models of care co-designed with communities.
| eISSN: | 2654-1459 |
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