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. 2009 Jul 23:9:124.
doi: 10.1186/1472-6963-9-124.

The index of rural access: an innovative integrated approach for measuring primary care access

Matthew R McGrail  1 , John S Humphreys
Affiliations

The index of rural access: an innovative integrated approach for measuring primary care access

Matthew R McGrail et al. BMC Health Serv Res. .

Abstract

Background: The problem of access to health care is of growing concern for rural and remote populations. Many Australian rural health funding programs currently use simplistic rurality or remoteness classifications as proxy measures of access. This paper outlines the development of an alternative method for the measurement of access to primary care, based on combining the three key access elements of spatial accessibility (availability and proximity), population health needs and mobility.

Methods: The recently developed two-step floating catchment area (2SFCA) method provides a basis for measuring primary care access in rural populations. In this paper, a number of improvements are added to the 2SFCA method in order to overcome limitations associated with its current restriction to a single catchment size and the omission of any distance decay function. Additionally, small-area measures for the two additional elements, health needs and mobility are developed. By utilising this improved 2SFCA method, the three access elements are integrated into a single measure of access. This index has been developed within the state of Victoria, Australia.

Results: The resultant index, the Index of Rural Access, provides a more sensitive and appropriate measure of access compared to existing classifications which currently underpin policy measures designed to overcome problems of limited access to health services. The most powerful aspect of this new index is its ability to identify access differences within rural populations at a much finer geographical scale. This index highlights that many rural areas of Victoria have been incorrectly classified by existing measures as homogenous in regards to their access.

Conclusion: The Index of Rural Access provides the first truly integrated index of access to primary care. This new index can be used to better target the distribution of limited government health care funding allocated to address problems of poor access to primary health care services in rural areas.

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Figures

Figure 1
Figure 1
Distribution of population centres within the state of Victoria.
Figure 2
Figure 2
Spatial accessibility of primary care in Victoria using the improved 2SFCA method.
Figure 3
Figure 3
Change to access scores after the addition of health needs.
Figure 4
Figure 4
The Index of Rural Access to primary care in Victoria.
See this image and copyright information in PMC

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