The index of rural access: an innovative integrated approach for measuring primary care access.

Matthew R Mcgrail,John S Humphreys

doi:10.1186/1472-6963-9-124

Abstract

BackgroundThe problem of access to health care is of growing concern for rural and remote populations. Many Australian rural health funding programs currently use simplistic rurality or remoteness classifications as proxy measures of access. This paper outlines the development of an alternative method for the measurement of access to primary care, based on combining the three key access elements of spatial accessibility (availability and proximity), population health needs and mobility.MethodsThe recently developed two-step floating catchment area (2SFCA) method provides a basis for measuring primary care access in rural populations. In this paper, a number of improvements are added to the 2SFCA method in order to overcome limitations associated with its current restriction to a single catchment size and the omission of any distance decay function. Additionally, small-area measures for the two additional elements, health needs and mobility are developed. By utilising this improved 2SFCA method, the three access elements are integrated into a single measure of access. This index has been developed within the state of Victoria, Australia.ResultsThe resultant index, the Index of Rural Access, provides a more sensitive and appropriate measure of access compared to existing classifications which currently underpin policy measures designed to overcome problems of limited access to health services. The most powerful aspect of this new index is its ability to identify access differences within rural populations at a much finer geographical scale. This index highlights that many rural areas of Victoria have been incorrectly classified by existing measures as homogenous in regards to their access.ConclusionThe Index of Rural Access provides the first truly integrated index of access to primary care. This new index can be used to better target the distribution of limited government health care funding allocated to address problems of poor access to primary health care services in rural areas.

Highlights

The problem of access to health care is of growing concern for rural and remote populations
In the absence of a national index of access, funding for most of these Australian programs is based on one of two rural classifications as surrogate measures of access [10] – either the Rural Remote and Metropolitan Areas (RRMA) classification [11] which divides all Statistical Local Areas (SLAs) into three zones and seven categories across these zones based on the size of the largest population centre within each SLA; or the Australian Standard Geographical Classification (ASGC) Remoteness index [12] which measures road distance to five hierarchical levels of service centres based on population size alone, the aggregated scores of which are separated into five hierarchical categories
The first is its restriction to using only one catchment size for all areas and for both Steps 1 and 2, while the second weakness is the omission of any measure of the variation of proximity within a catchment itself. Our research addresses both these issues through developing four distinct improvements which enable the calculation of more realistic catchments and related impedance functions [44,45]

Summary

Introduction

The problem of access to health care is of growing concern for rural and remote populations. Within Australia, numerous programs have been introduced by governments aimed at reducing access difficulties confronting rural populations [7]. Most of these programs target the provision of primary care services, because these are the gateway to the health system for most health care seekers. In the absence of a national index of access, funding for most of these Australian programs is based (rather inadequately) on one of two rural classifications as surrogate measures of access [10] – either the Rural Remote and Metropolitan Areas (RRMA) classification [11] which divides all Statistical Local Areas (SLAs) into three zones (metropolitan, rural and remote) and seven categories across these zones based on the size of the largest population centre within each SLA; or the Australian Standard Geographical Classification (ASGC) Remoteness index [12] which measures road distance (proximity) to five hierarchical levels of service centres (proxy for availability) based on population size alone, the aggregated scores of which are separated into five hierarchical categories

Methods

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Discussion

Conclusion