Improved Primary Health Care (PHC) utilisation is central to reducing the unacceptable morbidity and mortality rates characterising populations living in remote communities. Despite poorer health, significant inequity characterises the funding of PHC services in Australia’s most remote areas. This pilot study sought to ascertain what funding is required to ensure equitable access to sustainable, high quality primary health care irrespective of geographical remoteness of communities.
High performing remote Primary Health Care (PHC) services were selected using improvement measures from the Australian Primary Care Collaboratives Program and validated by health experts. Eleven PHC services provided data relating to the types of services provided, level of service utilisation, human resources, operating and capital expenses. A further four services that provide visiting PHC to remote communities provided information on the level and cost of these services. Demographic data for service catchment areas (including estimated resident population, age, Indigenous status, English spoken at home and workforce participation) were obtained from the Australian Bureau of Statistics 2011 census. Formal statistical inference (p-values) were derived in the linear regression via the nonparametric bootstrap.
A direct linear relationship was observed between the total cost of resident PHC services and population, while cost per capita decreased with increasing population. Services in smaller communities had a higher number of nursing staff per 1000 residents and provided more consultations per capita than those in larger communities. The number of days of visiting services received by a community each year also increased with population. A linear regression with bootstrapped statistical inference predicted a significant regression equation where the cost of resident services per annum is equal to $1,251,893.92 + ($1698.83 x population) and the cost of resident and visiting services is equal to $1,378,870.85 + ($2600.00 x population).
The research findings provide empirical evidence based on real costs to guide funding for remote PHC services that takes into account the safety and equity requirements for a minimum viable service. This method can be used as a transparent, coordinated approach to ensure the equitable delivery of sustainable, high quality PHC in remote communities. This will in turn contribute to improved health outcomes.
OECD. OECD Regions at a Glance 2013. Paris: OECD Publishing; 2013. http://dx.doi.org/10.1787/reg_glance-2013-en.
Steering Committee for the Review of Government Service Provision. Report on Government services volume 2: health; community services; housing and homelessness. Canberra: Productivity Commission; 2013.
Australian Institute of Health and Welfare. Australian health expenditure by remoteness - a comparison of remote, regional and city health expenditure, Health and welfare expenditure series. Canberra: AIHW; 2010.
Moran M, Porter D, Curth-Bibb J. Funding indigenous organisations: improving governance performance through innovations in public finance management in remote Australia. Issues paper no 11. Canberra: AIHW and Melbourne: Australian Institute of Family Studies; 2014.
Alford K. Economic value of aboriginal community controlled health services. Canberra: National Aboriginal Community Controlled Health Organisation Press Club; 2014.
KPMG. Funding options to reform the distribution of OATSIH primary health care funding - consultation paper. Canberra: Department of Health and Ageing Government Advisory Services; 2012.
Zhao Y, Hanssens P, Byron P, Guthridge S. Cost estimates of primary health care activities for remote aboriginal communities in the Northern territory. Department of Health and Community Services: Darwin; 2006. http://digitallibrary.health.nt.gov.au/dspace/bitstream/10137/59/3/Primary_health_care_costs.pdf.
National Health and Hospitals Reform Commission: A healthier future for all Australians-final report of the National Health and Hospitals Reform Commission. Canberra: Commonwealth of Australia; 2009.
National Health and Hospitals Reform Commission. A healthier future for all Australians interim report. Canberra: Commonwealth of Australia; 2009.
OECD. OECD reviews of health care quality: Australia 2015: raising standards. Paris: OECD Publishing; 2015.
Humphreys JS. Social provision and service delivery: problems of equity, health, and health care in rural Australia. Geoforum. 1988;19(3):323–38. CrossRef
World Health Organisation. World Health Statistics 2016: monitoring health for the SDGs, sustainable development goals. Geneva: WHO publishing; 2016.
OECD. OECD territorial reviews: Northern sparsely populated areas. Paris: OECD Publishing; 2017.
Humphreys J, Solarsh G. Populations at special health risk: rural populations, The international encyclopedia of public health. Volume 5. 2nd ed. Oxford: Academic Press; 2017. p. 599–608.
Reserve Bank of Australia. Inflation Calculator http://www.rba.gov.au/calculator/ Accessed 14 June 2016.
Australian Bureau of Statistics 2011. Community Profiles. http://www.abs.gov.au/websitedbs/censushome.nsf/home/communityprofiles?opendocument& navpos=230 Accessed 23 Oct. 2015.
Allen and Clarke. Evaluation of the Child health Check Initiative and the Expanding health service delivery Initiative: final report. Canberra: Department of Health and Ageing; 2011.
IBM Corp. IBM SPSS Statistics for windows. In., version 22 edn. IBM Corp: Armonk NY; 2013.
Australian Government Productivity Commission. 2014 Indigenous Expenditure Report Data Tables. http://www.pc.gov.au/research/ongoing/indigenous-expenditure-report/indigenous-expenditure-report-2014#data-tables: Accessed 23 Feb 2016.
PHCRIS: Primary Health Care Funding Models. PHCRIS Research Roundup. 33 edn: PHCRIS; 2013.
Rice N, Smith P. Approaches to capitation and risk adjustment in health care: an international survey. York: The University of York Centre for Health Economics; 1999.
Segal L. A vision for primary care - funding and other system factors for optimising the primary care contribution to the community's. Adelaide: University of South Australia; 2008.
SCRGSP (Steering Committee for the Review of Government Service Provision). 2014 indigenous expenditure report. Canberra: Productivity Commission; 2014. p. 2014.
Mogyorosy Z, Smith P. The main methodological issues in costing health care services: a literature review. York UK: University of York, Centre for Health Economics; 2005.
Peacock S, Segal L. Equity and the funding of Australian health services prospects for weighted capitation. Centre for Health Program Evaluation: West Heidelberg; 1999.
Australian National Audit Office. Capacity development for indigenous service delivery: Department of Families, Housing, Community Services and Indigenous Affairs, Department of Education, employment, and workplace relations, Department of Health and Ageing. Commonwealth of Australia: Barton, A.C.T; 2012.
Australian Institute of Health and Welfare. Australian health expenditure by remoteness: a comparison of remote, regional and city health expenditure, Health and welfare expenditure series no. 50. Cat. No. HWE 50. Canberra: Australian Institute of Health and Welfare; 2011.
- Equitable resourcing of primary health care in remote communities in Australia’s Northern Territory: a pilot study
Susan L Thomas
John S Humphreys
- BioMed Central
Neu im Fachgebiet Allgemeinmedizin
Meistgelesene Bücher aus dem Fachgebiet
Sommerakademie-Visual, Mail Icon II