Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE (Open Access)

Subsidies to target specialist outreach services into more remote locations: a national cross-sectional study

Belinda G. O’Sullivan A B C E , Matthew R. McGrail B C and Johannes U. Stoelwinder D
+ Author Affiliations
- Author Affiliations

A Monash Rural Health, Monash University, Level 3, 26 Mercy Street, PO Box 666, Bendigo, Vic. 3550, Australia.

B MABEL Survey: Medicine in Australia: Balancing Employment and Life, Centre for Research Excellence in Medical Workforce Dynamics, Melbourne Institute of Applied Economic and Social Research, Barry Street, Melbourne, Vic. 3010, Australia.

C Monash Rural Health, Monash University, Northways Road, Churchill, Vic. 3842, Australia. Email: Matthew.mcgrail@monash.edu

D Department of Epidemiology and Preventive Medicine, Monash University, The Alfred, 6th Floor, 99 Commercial Road, Melbourne, Vic. 3004, Australia. Email: just.stoelwinder@monash.edu

E Corresponding author. Email: belinda.osullivan@monash.edu

Australian Health Review 41(3) 344-350 https://doi.org/10.1071/AH16032
Submitted: 4 February 2016  Accepted: 23 May 2016   Published: 4 July 2016

Abstract

Objective Targeting rural outreach services to areas of highest relative need is challenging because of the higher costs it imposes on health workers to travel longer distances. This paper studied whether subsidies have the potential to support the provision of specialist outreach services into more remote locations.

Methods National data about subsidies for medical specialist outreach providers as part of the Wave 7 Medicine in Australia: Balancing Employment and Life (MABEL) Survey in 2014.

Results Nearly half received subsidies: 19% (n = 110) from a formal policy, namely the Australian Government Rural Health Outreach Fund (RHOF), and 27% (n = 154) from other sources. Subsidised specialists travelled for longer and visited more remote locations relative to the non-subsidised group. In addition, compared with non-subsidised specialists, RHOF-subsidised specialists worked in priority areas and provided equally regular services they intended to continue, despite visiting more remote locations.

Conclusion This suggests the RHOF, although limited to one in five specialist outreach providers, is important to increase targeted and stable outreach services in areas of highest relative need. Other subsidies also play a role in facilitating remote service distribution, but may need to be more structured to promote regular, sustained outreach practice.

What is known about this topic? There are no studies describing subsidies for specialist doctors to undertake rural outreach work and whether subsidies, including formal and structured subsidies via the Australian Government RHOF, support targeted outreach services compared with no financial support.

What does this paper add? Using national data from Australia, we describe subsidisation among specialist outreach providers and show that specialists subsidised via the RHOF or another source are more likely to provide remote outreach services.

What are the implications for practitioners? Subsidised specialist outreach providers are more likely to provide remote outreach services. The RHOF, as a formally structured comprehensive subsidy, further targets the provision of priority services into such locations on a regular, ongoing basis.

Additional keywords: policy, remote services, outreach.


References

[1]  de Roodenbeke E, Lucas S, Rouzaut A, Bana F. Outreach services as a strategy to increase access to health workers in remote and rural areas. Technical report no. 2. Geneva: World Health Organization International Hospital Federation; 2011. Available at: http://whqlibdoc.who.int/publications/2011/9789241501514_eng.pdf [verified 31 May 2016].

[2]  O’Sullivan BG, Joyce CM, McGrail MR. Adoption, implementation and prioritization of specialist outreach policy in Australia: a national perspective. Bull World Health Organ 2014; 92 512–19.
Adoption, implementation and prioritization of specialist outreach policy in Australia: a national perspective.CrossRef | 25110376PubMed |

[3]  Australian Institute of Health and Welfare (AIHW). National health workforce data set. Medical practitioners 2014. Canberra: AIHW; 2015. Available at: http://www.aihw.gov.au/workforce/medical/additional/ [verified 31 May 2016].

[4]  O’Sullivan B, Joyce C, McGrail M. Rural outreach by specialist doctors in Australia: a national cross-sectional study of supply and distribution. Hum Resour Health 2014; 12 1–10.
Rural outreach by specialist doctors in Australia: a national cross-sectional study of supply and distribution.CrossRef |

[5]  Department of Health and Ageing. Rural Health Outreach Fund service delivery standards: rural and regional health Australia. Canberra: Department of Health and Ageing; 2012. Available at: http://www.ruralhealthaustralia.gov.au/internet/rha/publishing.nsf/Content/RHOF-service-delivery-standards [verified 31 May 2016].

[6]  Gadiel D, Ridoutt L, Bune A, Cheang C, Cook K, Thiele D. Evaluation of outreach models of medical specialist service delivery. Sydney: Human Capital Alliance International; 2004. Available at: http://www.humancapitalalliance.com.au/downloads/DH28%20Specialist%20outreach%20model%20evaluation.PDF [verified 31 May 2016].

[7]  Health Policy Analysis. Evaluation of the Medical Specialist Outreach Assistance Program and the Visiting Optometrists Scheme: final report, volume 1. Canberra: Department of Health and Ageing; 2011. Available at: http://www.ruralhealthaustralia.gov.au/internet/rha/publishing.nsf/Content/B5834BF6038FA090CA257A4C00255757/$File/DoHA-Evaluation_of_MSOAP_and_VOS_final_report_Volume%201.pdf [verified 31 May 2016].

[8]  Broadbent A, McKenzie J. Wagga Wagga specialist outreach palliative medicine service: a report on the first 12 months of service. Aust J Rural Health 2006; 14 219–24.
Wagga Wagga specialist outreach palliative medicine service: a report on the first 12 months of service.CrossRef | 17032299PubMed |

[9]  Gruen RL, Weeramanthri TS, Bailie RS. Outreach and improved access to specialist services for indigenous people in remote Australia: the requirements for sustainability. J Epidemiol Community Health 2002; 56 517–21.
Outreach and improved access to specialist services for indigenous people in remote Australia: the requirements for sustainability.CrossRef | 1:STN:280:DC%2BD38zjslKguw%3D%3D&md5=f4f570a2184be883f52c9fecf04a7ba7CAS | 12080159PubMed |

[10]  Goss PW, Paterson MA, Renalson JA. ‘Radical’ new rural model for pediatric diabetes care. Pediatr Diabetes 2010; 11 296–304.
‘Radical’ new rural model for pediatric diabetes care.CrossRef | 19895408PubMed |

[11]  Chittleborough T, Lourensz K, Elliot M, Thomas P, Franzi S. Outreach surgical consulting services in North East Victoria. Aust J Rural Health 2013; 21 325–8.
Outreach surgical consulting services in North East Victoria.CrossRef | 24299437PubMed |

[12]  Joyce C, Scott A, Jeon S-H, Humphreys J, Kalb G, Witt J, Leahy A. The ‘Medicine in Australia: Balancing Employment and Life (MABEL)’ longitudinal survey: Protocol and baseline data for a prospective cohort study of Australian doctors’ workforce participation. BMC Health Serv Res 2010; 10 50
The ‘Medicine in Australia: Balancing Employment and Life (MABEL)’ longitudinal survey: Protocol and baseline data for a prospective cohort study of Australian doctors’ workforce participation.CrossRef | 20181288PubMed |

[13]  Yan W, Cheng TC, Scott A, Joyce CM, Humphreys J, Kalb G, Leahy A. Medicine in Australia: Balancing Employment and Life (MABEL). Aust Econ Rev 2011; 44 102–12.
Medicine in Australia: Balancing Employment and Life (MABEL).CrossRef |

[14]  Australian Bureau of Statistics (ABS). The Australian statistical geography standard (ASGS) remoteness structure. Canberra: ABS; 2011. Available at: http://www.abs.gov.au/websitedbs/d3310114.nsf/home/remoteness+structure#Anchor1 [verified 31 May 2016].

[15]  O’Sullivan B, Stoelwinder J, Joyce C, McGrail M. Service distribution and models of rural outreach by specialist doctors in Australia: a national cross-sectional study Aust Health Rev 2016; 40 330–6.
Service distribution and models of rural outreach by specialist doctors in Australia: a national cross-sectional studyCrossRef |

[16]  O’Sullivan B, Stoelwinder J, McGrail M. The stability of rural outreach services: a national longitudinal study of specialist doctors. Med J Aust 2015; 203 297e1–e6.
The stability of rural outreach services: a national longitudinal study of specialist doctors.CrossRef |

[17]  Australasian Medical Publishing Company (AMPCo) Direct. Australian medical directory dataset. Sydney: AMPCo Direct; 2008.


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