Matthew R McGrail1, John S Humphreys. 1. Gippsland Medical School and School of Rural Health, Monash University, Victoria. matthew.mcgrail@med.monash.edu.au
Abstract
OBJECTIVE: To outline a new index of access to primary care services in rural areas that has been specifically designed to overcome weaknesses of using existing geographical classifications. METHODS: Access was measured by four key dimensions of availability, proximity, health needs and mobility. Population data were obtained through the national census and primary care service data were obtained through the Medical Directory of Australia. All data were calculated at the smallest feasible geographical unit (collection districts). The index of access was measured using a modified two-step floating catchment area (2SFCA) method, which incorporates two necessary additional spatial functions (distance-decay and capping) and two additional non-spatial dimensions (health needs and mobility). RESULTS: An improved index of access, specifically designed to better capture access to primary care in rural areas, is achieved. These improvements come from: 1) incorporation of actual health service data in the index; 2) methodological improvements to existing access measures, which enable both proximity to be differentiated within catchments and the use of varying catchment sizes; and 3) improved sensitivity to small-area variations. CONCLUSION: Despite their recognised weaknesses, the Australian government uses broad geographical classifications as proxy measures of access to underpin significant rural health funding programs. This new index of access could provide a more equitable means for resource allocation. IMPLICATIONS: Significant government funding, aimed at improving health service access inequities in rural areas, could be better targeted by underpinning programs with our improved access measure.
OBJECTIVE: To outline a new index of access to primary care services in rural areas that has been specifically designed to overcome weaknesses of using existing geographical classifications. METHODS: Access was measured by four key dimensions of availability, proximity, health needs and mobility. Population data were obtained through the national census and primary care service data were obtained through the Medical Directory of Australia. All data were calculated at the smallest feasible geographical unit (collection districts). The index of access was measured using a modified two-step floating catchment area (2SFCA) method, which incorporates two necessary additional spatial functions (distance-decay and capping) and two additional non-spatial dimensions (health needs and mobility). RESULTS: An improved index of access, specifically designed to better capture access to primary care in rural areas, is achieved. These improvements come from: 1) incorporation of actual health service data in the index; 2) methodological improvements to existing access measures, which enable both proximity to be differentiated within catchments and the use of varying catchment sizes; and 3) improved sensitivity to small-area variations. CONCLUSION: Despite their recognised weaknesses, the Australian government uses broad geographical classifications as proxy measures of access to underpin significant rural health funding programs. This new index of access could provide a more equitable means for resource allocation. IMPLICATIONS: Significant government funding, aimed at improving health service access inequities in rural areas, could be better targeted by underpinning programs with our improved access measure.
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