Subsidies to target specialist outreach services into more remote locations: a national cross-sectional study

Abstract

Objective. Targeting rural outreach services to areas of highest relative need is challenging because of the higher costs it imposes on health workers to travel longer distances. This paper studied whether subsidies have the potential to support the provision of specialist outreach services into more remote locations.Methods. National data about subsidies for medical specialist outreach providers as part of the Wave 7 Medicine in Australia: Balancing Employment and Life (MABEL) Survey in 2014.Results. Nearly half received subsidies: 19% (n = 110) from a formal policy, namely the Australian Government Rural Health Outreach Fund (RHOF), and 27% (n = 154) from other sources. Subsidised specialists travelled for longer and visited more remote locations relative to the non-subsidised group. In addition, compared with non-subsidised specialists, RHOF-subsidised specialists worked in priority areas and provided equally regular services they intended to continue, despite visiting more remote locations.Conclusion. This suggests the RHOF, although limited to one in five specialist outreach providers, is important to increase targeted and stable outreach services in areas of highest relative need. Other subsidies also play a role in facilitating remote service distribution, but may need to be more structured to promote regular, sustained outreach practice. What is known about this topic?There are no studies describing subsidies for specialist doctors to undertake rural outreach work and whether subsidies, including formal and structured subsidies via the Australian Government RHOF, support targeted outreach services compared with no financial support. What does this paper add? Using national data from Australia, we describe subsidisation among specialist outreach providers and show that specialists subsidised via the RHOF or another source are more likely to provide remote outreach services. What are the implications for practitioners? Subsidised specialist outreach providers are more likely to provide remote outreach services. The RHOF, as a formally structured comprehensive subsidy, further targets the provision of priority services into such locations on a regular, ongoing basis.

Reviewing reliance on overseas-trained doctors in rural Australia and planning for self-sufficiency: applying 10 years' MABEL evidence

“…In Australia, a national policy subsidises travel costs for 20% of all specialist outreach workers. Those supported by this are more likely to be specialists in fields related to national rural health priority areas and to visit more remote locations [44, 45].…”

Specialist outreach services in regional and remote Australia: key drivers and policy implications

“…This suggests that there may be cost implications related to specialists self‐funding their travel costs and absorbing the costs of travel time, which are likely to increase as specialists travel to more distant or hard to reach communities. We found that subsidies, whether provided to outreach specialists from the RHOF or another source, increased the rate of more remote area services by up to 4.4 times 16 . Additionally, RHOF subsidies relate to more regular outreach services in remote locations, with 62% of these specialists intending to continue for 5 or more years.…”

“…About half of the specialists undertake outreach work without any support from subsidies, with the remainder supported by the RHOF (19%) or other types of subsidies (27%). This suggests that specialists incur some personal costs of time and travel for outreach participation, although 33% of non‐subsidised providers work publicly, potentially covered by salaried arrangements 16 …”

“…This suggests that specialists incur some personal costs of time and travel for outreach participation, although 33% of non-subsidised providers work publicly, potentially covered by salaried arrangements. 16 A wide range of factors relate to participation and influence the distribution and sustainability of specialist outreach services. These can mainly be categorised according to individual, organisational or economic domains.…”

“…We found that subsidies, whether provided to outreach specialists from the RHOF or another source, increased the rate of more remote area services by up to 4.4 times. 16 Additionally, RHOF subsidies relate to more regular outreach services in remote locations, with 62% of these specialists intending to continue for 5 or more years. Non-subsidised specialists tend to target outreach services to larger, nearby towns, where clinical throughput is likely to be higher and more financially sustainable.…”