title: Adoption, implementation and prioritization of specialist outreach policy in Australia: a national perspective.
abstract: The World Health Organization has endorsed the use of outreach to promote: efficient redeployment of the health-care workforce; continuity of care at the local level; and professional support for local, rural, health-care workers. Australia is the only country that has had, since 2000, a sustained national policy on outreach for subsidizing medical specialist outreach to rural areas. This paper describes the adoption, implementation and prioritization of a national specialist outreach policy in Australia. Adoption of the national policy followed a long history of successful outreach, largely driven by the professional interest and personal commitment of the workforce. Initially the policy supported only new outreach services but concerns about the sustainability of existing services resulted in eligibility for funding being extended to all specialist services. The costs of travel, travel time, accommodation, professional support, staff relief at specialists' primary practices and equipment hire were subsidized. Over time, a national political commitment to the equitable treatment of indigenous people resulted in more targeted support for outreach in remote areas. Current priorities are: (i) establishing team-based outreach services; (ii) improving local staff's skills; (iii) achieving local coordination; and (iv) conducting a nationally consistent needs assessment. The absence of subsidies for specialists' clinical work can discourage private specialists from providing services in remote areas where clinical throughput is low. To be successful, outreach policy must harmonize with the interests of the workforce and support professional autonomy. Internationally, the development of outreach policy must take account of the local pay and practice conditions of health workers.
authors.affiliation: School of Rural Health, Monash University, 26 Mercy Street (Level 3), PO Box 666, Bendigo, Victoria, 3550, Australia .
authors.forename: Belinda G
authors.initials: BG
authors.lastname: O'Sullivan
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia .
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Joyce
authors.affiliation: Monash University Gippsland Medical School, Churchill, Australia .
authors.forename: Matthew R
authors.initials: MR
authors.lastname: McGrail
mesh_terms: D001315:Australia; D006291:Health Policy; D006292:Health Priorities; D006293:Health Promotion / Q000458:organization & administration*; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D019035:Rural Health Services; D013038:Specialization; D000078329:Workforce; D014944:World Health Organization
references.citation: Lancet. 2006 Jul 8;368(9530):130-8
references.pmid: 16829297
references.citation: Health Econ. 2012 Nov;21(11):1300-17
references.pmid: 21919116
references.citation: Aust J Rural Health. 2006 Oct;14(5):219-24
references.pmid: 17032299
references.citation: J Paediatr Child Health. 2001 Apr;37(2):113-7
references.pmid: 11328463
references.citation: J Epidemiol Community Health. 2002 Jul;56(7):517-21
references.pmid: 12080159
references.citation: Trop Med Int Health. 2011 Oct;16(10):1268-75
references.pmid: 21718395
references.citation: Med J Aust. 2010 Mar 1;192(5):248-53
references.pmid: 20201757
references.citation: World J Surg. 2009 Aug;33(8):1562-7
references.pmid: 19495863
references.citation: Med J Aust. 2001 Oct 1;175(7):371-2
references.pmid: 11700815
references.citation: Heart Lung Circ. 2010 May-Jun;19(5-6):361-6
references.pmid: 20381420
references.citation: Clin Exp Ophthalmol. 2011 May-Jun;39(4):344-9
references.pmid: 21105975
references.citation: Aust J Rural Health. 2001 Feb;9(1):34-7
references.pmid: 11703265
references.citation: Soc Sci Med. 2013 Sep;92:74-82
references.pmid: 23849281
references.citation: Injury. 2003 Sep;34(9):649-51
references.pmid: 12951287
references.citation: ANZ J Surg. 2001 Sep;71(9):544-7
references.pmid: 11527266
references.citation: Bull World Health Organ. 2010 May;88(5):379-85
references.pmid: 20461133
references.citation: J Emerg Med. 2009 May;36(4):363-8
references.pmid: 18814993
references.citation: Australas Psychiatry. 2006 Sep;14(3):295-9
references.pmid: 16923042
references.citation: Blood Purif. 2006;24(1):115-22
references.pmid: 16361851
references.citation: Health Policy. 2013 Jun;111(1):43-51
references.pmid: 23602546
references.citation: Clin Exp Ophthalmol. 2011 May-Jun;39(4):350-7
references.pmid: 21105976
references.citation: Med J Aust. 2007 May 21;186(10):519-21
references.pmid: 17516899
references.citation: Med J Aust. 2009 Dec 7-21;191(11-12):602-4
references.pmid: 20028276
references.citation: Rural Remote Health. 2006 Oct-Dec;6(4):502
references.pmid: 17107272
references.citation: Rural Remote Health. 2010 Jul-Sep;10(3):1402
references.pmid: 20722462
references.citation: Australas Psychiatry. 2004 Jun;12(2):161-5
references.pmid: 15715762
references.citation: Aust Health Rev. 2000;23(4):8-26
references.pmid: 11256274
references.citation: Health Policy. 2007 Dec;84(2-3):142-52
references.pmid: 17449134
references.citation: Br Med J (Clin Res Ed). 1987 Jan 24;294(6566):233-5
references.pmid: 3101824
references.citation: Med J Aust. 2012 Aug 20;197(4):244-5
references.pmid: 22900877