title: 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.
authors.affiliation: Monash Rural Health, Monash University, Level 3, 26 Mercy Street, PO Box 666, Bendigo, Vic. 3550, Australia.
authors.forename: Belinda G
authors.initials: BG
authors.lastname: O'Sullivan
authors.affiliation: MABEL Survey: Medicine in Australia: Balancing Employment and Life, Centre for Research Excellence in Medical Workforce Dynamics, Melbourne Institute of Applied Economic and Social Research, Barry Street, Melbourne, Vic. 3010, Australia.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: McGrail
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, The Alfred, 6th Floor, 99 Commercial Road, Melbourne, Vic. 3004, Australia. Email.
authors.forename: Johannes U
authors.initials: JU
authors.lastname: Stoelwinder
mesh_terms: D001315:Australia; D003430:Cross-Sectional Studies; D005380:Financing, Government; D006291:Health Policy; D006801:Humans; D008137:Longitudinal Studies; D008507:Medically Underserved Area; D019035:Rural Health Services / Q000191:economics*; D013038:Specialization / Q000191:economics*; D000078329:Workforce