title: A review of rural and remote health service indexes: are they relevant for the development of an Australian rural birth index?
abstract: BACKGROUND
  Policy informs the planning and delivery of rural and remote maternity services and influences the perinatal outcomes of the 30 per cent of Australian women and their babies who live outside the major cities. Currently however, there are no planning tools that identify the optimal level of birthing services for rural and remote communities in Australia. To address this, the Australian government has prioritised the development of a rigorous methodology in the Australian National Maternity Services Plan to inform the planning of rural and remote maternity services.
  
  
  METHODS
  A review of the literature was undertaken to identify planning indexes with component variables as outlined in the Australian National Maternity Services Plan. The indexes were also relevant if they described need associated with a specific type and level of health service in rural and remote areas of high income countries. Only indexes that modelled a range of socioeconomic and or geographical variables, identified access or need for a specific service type in rural and remote communities were included in the review.
  
  
  RESULTS
  Four indexes, two Australian and two Canadian met the inclusion criteria. They used combinations of variables including: geographical placement of services; isolation from services and socioeconomic vulnerability to identify access to a type and level of health service in rural and remote areas within 60 minutes. Where geographic isolation reduces access to services for high needs populations, additional measures of disadvantage including indigeneity could strengthen vulnerability scores.
  
  
  CONCLUSIONS
  Current planning indexes are applicable for the development of an Australian rural birthing index. The variables in each of the indexes were relevant, however use of flexible sized catchments to accurately account for population births and weighting for extreme geographic isolation needs to be considered. Additionally, socioeconomic variables are required that will reflect need for services particularly for isolated high needs populations. These variables could be used with Australian data and appropriate cut-off points to confirm applicability for maternity services. All of the indexes used similar types of variables and are relevant for the development of an Australian Rural Birth Index.
authors.affiliation: University Centre for Rural Health, University of Sydney, Uralba st, Lismore, NSW, Australia. jpil2286@uni.sydney.edu.au.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pilcher
authors.affiliation: University Centre for Mothers and Babies, University of Queensland, St Lucia, Brisbane, Australia. sue.kruske@uq.edu.au.
authors.forename: Sue
authors.initials: S
authors.lastname: Kruske
authors.affiliation: University Centre for Rural Health, University of Sydney, Uralba st, Lismore, NSW, Australia. lesley.barclay@sydney.edu.au.
authors.forename: Lesley
authors.initials: L
authors.lastname: Barclay
mesh_terms: D001315:Australia; D001723:Birth Rate; D002170:Canada; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006771:Hospitals, Maternity / Q000458:organization & administration*; D006779:Hospitals, Public / Q000458:organization & administration*; D006801:Humans; D008507:Medically Underserved Area; D011247:Pregnancy; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors