Abstract
The Australian Government's recent decision to replace the Rural Remote and Metropolitan Area (RRMA) classification with the Australian Standard Geographical Classification - Remoteness Areas (ASGC-RA) system highlights the ongoing significance of geographical classifications for rural health policy, particularly in relation to improving the rural health workforce supply. None of the existing classifications, including the government's preferred choice, were designed specifically to guide health resource allocation, and all exhibit strong weaknesses when applied as such. Continuing reliance on these classifications as policy tools will continue to result in inappropriate health program resource distribution. Purely 'geographical' classifications alone cannot capture all relevant aspects of rural health service provision within a single measure. Moreover, because many subjective decisions (such as the choice of algorithm and breakdown of groupings) influence a classification's impact and acceptance from its users, policy-makers need to specify explicitly the purpose and role of their different programs as the basis for developing and implementing appropriate decision tools such as 'rural-urban' classifications. Failure to do so will continue to limit the effectiveness that current rural health support and incentive programs can have in achieving their objective of improving the provision of health care services to rural populations though affirmative action programs.
Highlights
"From 1 July 2009, the outdated and flawed Rural, Remote and Metropolitan Areas (RRMA) system will be replaced by the Australian Standard Geographical Classification - Remoteness Areas (ASGC-RA) system" [1]
The aim of this paper is to show why geographical classifications have such an important influence for workforce recruitment and retention policies and incentives in non-metropolitan areas
Geographical classifications are a significant part of rural health workforce policy, as the government endeavours to improve or at least maintain the rural health workforce supply
Summary
"From 1 July 2009, the outdated and flawed Rural, Remote and Metropolitan Areas (RRMA) system will be replaced by the Australian Standard Geographical Classification - Remoteness Areas (ASGC-RA) system" [1]. McGrail's new index of rural access, tested in Victoria, has been developed as a more appropriate measure of access to primary care services in rural areas [50,51] This index is designed to include the key elements of access to GPs (availability, proximity, mobility and health needs), utilise more appropriate advanced accessibility methods (modified two-step floating catchment areas [52,53]) and use the smallest feasible geographical units (collection districts). Bundling together places of diversity (heterogeneous) into convenient (presumed homogenous) categories often obscures the inherent variations within rural areas [63] and seriously affects the resultant pattern of health status and differentiation [64] Many possible covariates, such as differing demographics, socio-economic status, access to health services and health behaviour, are frequently not included within statistical reports that are broken down by geography, despite their possible influence on the extent to which apparent associations with rurality are significant. While significant associations between geographical classifications and various health and health service outcomes are interesting, they often conceal the true effect within rural populations
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