Index of Access: a new innovative and dynamic tool for rural health service and workforce planningMatthew R. McGrail A C D , Deborah J. Russell B C and John S. Humphreys B C
A Monash University, School of Rural Health, Northways Road, Churchill, Vic. 3842, Australia.
C Centre of Research Excellence in Rural and Remote Primary Health Care, PO Box 666, Bendigo, Vic. 3552, Australia.
D Corresponding author. Email: email@example.com
Australian Health Review - https://doi.org/10.1071/AH16049
Submitted: 16 February 2016 Accepted: 12 July 2016 Published online: 19 August 2016
Objective Improving access to primary health care (PHC) remains a key issue for rural residents and health service planners. This study aims to show that how access to PHC services is measured has important implications for rural health service and workforce planning.
Methods A more sophisticated tool to measure access to PHC services is proposed, which can help health service planners overcome the shortcomings of existing measures and long-standing access barriers to PHC. Critically, the proposed Index of Access captures key components of access and uses a floating catchment approach to better define service areas and population accessibility levels. Moreover, as demonstrated through a case study, the Index of Access enables modelling of the effects of workforce supply variations.
Results Hypothetical increases in supply are modelled for a range of regional centres, medium and small rural towns, with resulting changes of access scores valuable to informing health service and workforce planning decisions.
Conclusions The availability and application of a specific ‘fit-for-purpose’ access measure enables a more accurate empirical basis for service planning and allocation of health resources. This measure has great potential for improved identification of PHC access inequities and guiding redistribution of PHC services to correct such inequities.
What is known about the topic? Resource allocation and health service planning decisions for rural and remote health settings are currently based on either simple measures of access (e.g. provider-to-population ratios) or proxy measures of access (e.g. standard geographical classifications). Both approaches have substantial limitations for informing rural health service planning and decision making.
What does this paper add? The adoption of a new improved tool to measure access to PHC services, the Index of Access, is proposed to assist health service and workforce planning. Its usefulness for health service planning is demonstrated using a case study to hypothetically model changes in rural PHC workforce supply.
What are the implications for practitioners? The Index of Access has significant potential for identifying how rural and remote primary health care access inequities can be addressed. This critically important information can assist health service planners, for example those working in primary health networks, to determine where and how much redistribution of PHC services is needed to correct existing inequities.
Additional keywords: primary care, resource allocation.
References Australian Health Ministers’ Conference. National rural health strategy. Canberra: Australian Government Publishing Service; 1994.
 Health Workforce Australia (HWA). National rural and remote health workforce innovation and reform strategy. Adelaide: HWA; 2013.
 Marchildon G. Health systems in transition: Canada. Toronto: University of Toronto Press; 2013.
 Zurn P, Dal Poz MR, Stilwell B, Adams O. Imbalance in the health workforce. Hum Resour Health 2004; 2 13
| Imbalance in the health workforce.CrossRef | 15377382PubMed |
 Dussault G, Franceschini MC. Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce. Hum Resour Health 2006; 4 12
| Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce.CrossRef | 16729892PubMed |
 McGrail MR, Humphreys JS, Joyce C, Scott A, Kalb G. Rural amenity and medical workforce shortage: is there a relationship? Geogr Res 2011; 49 192–202.
| Rural amenity and medical workforce shortage: is there a relationship?CrossRef |
 Argent N, Tonts M, Jones R, Holmes J. The amenity principle, internal migration, and rural development in Australia. Ann Assoc Am Geogr 2014; 104 305–18.
| The amenity principle, internal migration, and rural development in Australia.CrossRef |
 Schmitz DF, Baker E, Nukui A, Epperly T. Idaho rural family physician workforce study: the Community Apgar Questionnaire. Rural Remote Health 2011; 11 1769
| 1:STN:280:DC%2BC3MjhsVamtA%3D%3D&md5=a16600aea0a6d06c0c99dffa0d9e8642CAS | 21790262PubMed |
 Rural Doctors Association of Australia (RDAA), Monash University School of Rural Health. Viable models of rural and remote practice. Stage 1 and Stage 2 reports. Canberra: RDAA; 2003.
 Standing Council on Health. National strategic framework for rural and remote health. Canberra: Commonwealth of Australia; 2012.
 Health Workforce Australia (HWA). Australia’s health workforce series – doctors in focus. Adelaide: HWA; 2012.
 Department of Health. Doctor Connect: work as a doctor in Australia – ASGC Remoteness Areas (2006). Canberra: Australian Government. Available at: http://www.doctorconnect.gov.au/internet/otd/Publishing.nsf/Content/locator [verified 29 July 2016].
 Australian Bureau of Statistics (ABS). Australian statistical geography standard (ASGS) – main structure Canberra: ABS; 2011. Available at: http://www.abs.gov.au/websitedbs/D3310114.nsf/home/Australian+Statistical+Geography+Standard+(ASGS) [verified 20 May 2016].
 Australian Government Department of Health and Ageing. District of workforce shortage factsheet. 2013. Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/work-pr-dws-fact [verified 7 January 2016].
 McGrail MR, Humphreys JS. Measuring spatial accessibility to primary care in rural areas: improving the effectiveness of the two-step floating catchment area method. Appl Geogr 2009; 29 533–41.
| Measuring spatial accessibility to primary care in rural areas: improving the effectiveness of the two-step floating catchment area method.CrossRef |
 Australian Institute of Health and Welfare (AIHW). Rural, regional and remote health: a guide to remoteness classifications. AIHW Cat. No. PHE 53. Canberra: AIHW; 2004.
 Department of Health. Rural Classification Refore – Frequently Asked Questions. Canberra: Australian Government. Available at: (http://www.doctorconnect.gov.au/internet/otd/publishing.nsf/content/classificationchanges [verified 25 July 2016].
 Department of Health. Doctor Connect: work as a doctor in Australia – Modified Monash Model. Available at: http://www.doctorconnect.gov.au/internet/otd/publishing.nsf/content/MMM_locator [verified 25 July 2016].
 Humphreys JS, McGrail MR, Joyce CM, Scott A, Kalb G. Who should receive recruitment and retention incentives? Improved targeting of rural doctors using medical workforce data. Aust J Rural Health 2012; 20 3–10.
| Who should receive recruitment and retention incentives? Improved targeting of rural doctors using medical workforce data.CrossRef | 22250870PubMed |
 Penchansky R, Thomas JW. The concept of access: definition and relationship to consumer satisfaction. Med Care 1981; 19 127–40.
| The concept of access: definition and relationship to consumer satisfaction.CrossRef | 1:STN:280:DyaL3M7kslahug%3D%3D&md5=a2ab9994ed78cee60ab8e7e6896bd7a2CAS | 7206846PubMed |
 Russell DJ, Humphreys JS, Ward B, Chisholm M, Buykx P, McGrail M, Wakerman J. Helping policy-makers address rural health access problems. Aust J Rural Health 2013; 21 61–71.
| Helping policy-makers address rural health access problems.CrossRef | 23586567PubMed |
 Khan AA, Bhardwaj SM. Access to health care. A conceptual framework and its relevance to health care planning. Eval Health Prof 1994; 17 60–76.
| Access to health care. A conceptual framework and its relevance to health care planning.CrossRef | 1:STN:280:DyaK2c7osFKksQ%3D%3D&md5=c6929054daa20dd8fc2de248a82d89b4CAS | 10132481PubMed |
 Andersen RM. National health surveys and the behavioral model of health services use. Med Care 2008; 46 647–53.
| National health surveys and the behavioral model of health services use.CrossRef | 18580382PubMed |
 Saurman E. Improving access: modifying Penchansky and Thomas’s theory of access. J Health Serv Res Policy 2016; 21 36–9.
| Improving access: modifying Penchansky and Thomas’s theory of access.CrossRef | 26377728PubMed |
 McGrail MR, Humphreys JS. Spatial access disparities to primary health care in rural and remote Australia. Geospat Health 2015; 10 138–43.
| Spatial access disparities to primary health care in rural and remote Australia.CrossRef |
 Luo W, Wang F. Measures of spatial accessibility to health care in a GIS environment: synthesis and a case study in the Chicago region. Environ Plann B 2003; 30 865–84.
| Measures of spatial accessibility to health care in a GIS environment: synthesis and a case study in the Chicago region.CrossRef |
 McGrail MR, Humphreys JS. The index of rural access: an innovative integrated approach for measuring primary care access. BMC Health Serv Res 2009; 9 124
| The index of rural access: an innovative integrated approach for measuring primary care access.CrossRef | 19624859PubMed |
 Barlet M, Coldefy M, Collin C, Lucas-Gabrielli V. Localised potential accessibility (APL): a new measure of accessibility to general practitioners. Paris: Direction de la recherche, des études, de l’évaluation et des statistiques (DREES); 2012.
 Australian Institute of Health and Welfare (AIHW). Access to primary health care relative to need for Indigenous Australians. Catalogue no. IHW 128. Canberra: AIHW; 2014.
 Raven M, Butler C, Bywood P. Video-based telehealth in Australian primary health care: current use and future potential. Aust J Primary Health 2013; 19 283–6.
| Video-based telehealth in Australian primary health care: current use and future potential.CrossRef |