title: Do health and medical workforce shortages explain the lower rate of rural consumers' complaints to Victoria's Health Services Commissioner?
abstract: OBJECTIVE
  To identify which explanations account for lower rural rates of complaint about health services--(i) fear of consequences where there is little choice of alternative provider; (ii) a higher complaint threshold for rural consumers; (iii) lack of access to complaint mechanisms; or (iv) reduced access to services about which to complain.
  
  
  METHODS
  Ecological study incorporating consumer complaint, population and workforce distribution data sources.
  
  
  METHODS
  All health care providers practising in Victoria.
  
  
  METHODS
  De-identified records of all closed consumer complaints made to the Health Services Commissioner, Victoria, between March 1988 and April 2001 by Victorian residents (13 856 records).
  
  
  METHODS
  Differences in the percentage of under-representation in complaint rates in total and for each of four categories of health services providers for different size communities.
  
  
  RESULTS
  No consistent relationship was observed between community size and either degree of under-representation of complaints against any category of provider, or the proportion of serious or substantial complaints. Rural under-representation was highest (41%) for dentists, the provider category with the lowest proportion working in rural areas (17%), and lowest (18%) for hospitals, with the highest representation in rural areas (28% of beds). More rural complaints were about access issues (10.7% rural and 8.4% metropolitan).
  
  
  CONCLUSIONS
  Reduced opportunity to use health services due to rural health and medical workforce shortages was the best-supported explanation for the lower rural complaint rate. Workforce shortages impact on the quality of rural health services and on residents' opportunities to improve their health status.
authors.affiliation: School of Rural Health Research, Monash University, PO Box 666, Bendigo Central, Victoria 3552, Australia. judith.jones@med.monash.edu.au
authors.forename: Judith A
authors.initials: JA
authors.lastname: Jones
authors.forename: John S
authors.initials: JS
authors.lastname: Humphreys
authors.forename: Beth
authors.initials: B
authors.lastname: Wilson
mesh_terms: D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D008507:Medically Underserved Area; D010344:Patient Advocacy / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D012111:Residence Characteristics; D019035:Rural Health Services / Q000458:organization & administration*; D014739:Victoria; D000078329:Workforce