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Rural Health System Resources


What is the purpose of Rural Health Plus? Rural, remote and Aboriginal people cannot meaningfully participate in discussions about their health priorities, services, systems or structures without access to information and knowledge about how the system works, the needs of local towns, or what works and what doesn't work in our context.  Without health system literacy, there is a risk that community engagement becomes a one-way street, rather than a shared exploration of issues and opportunities.   This collection of resources, articles, toolkits and guides aims to help rural and remote people build their knowledge and literacy about the health system and what works in addressing the health needs and aspirations of rural and remote communities.

How are resources selected for inclusion? The resources have been selected by rural health experts who are committed to addressing rural health inequities.  The goal is to make it as easy as possible for rural and remote people to access the information they need to help make decisions and advocate for their own needs. Rural Health Plus has deliberately avoided including resources about things that have been proven not to work or where there no evidence of a systemic and meaningful impact on rural and remote access to primary care. The aim of Rural Heath Plus is to cut through all the noise and focus on things that work, that rural and remote people can control, and that deliver real improvements in access to local health care and jobs in local economies.  ​ For example, if two programs or approaches deliver similar outcomes in terms of rural health access but one is run out of the city and the other is run in a local rural community, we will only include a resource about the one run in the rural community because this delivers a wider range of flow-on benefits to our communities and delivers the same or similar outcomes. A core focus is on approaches that have been successfully tried elsewhere and/or evidence-based approaches to improving rural and remote access to health care.  There is a big focus on tools to help communities organise at a local level and advocate for changes in the way health care is delivered in their local community.

​​How do I use Rural Health Plus? Use the Keyword search below to select a topic and access a summary of articles, strategies, policies and programs.


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Political Determinants of Health: Healthcare Privatization and Population Health in Europe

Healthcare reforms result in policy outputs that influence the provision of medical services, which have consequences for the health of the population. This paper looks at whether health policies actually lead to improvements in population health, using an original dataset of healthcare reforms passed in 36 European countries from 1989 to 2019. Focusing more specifically on legislative changes implying privatisation of healthcare delivery and finance, we ask the following question: What is the relationship between reforms that privatise healthcare provision and population health in terms of health outcomes and inequalities? We answer this question by relying on fixed effects time-series cross-section models. Health outcomes are operationalised using measures of subjective health status, unmet health needs and resulting health inequalities. Our results show that privatisation of healthcare is associated with higher rates of poor health and unmet health needs several years after the passing of reforms. These effects are stronger for individuals in the lower tiers of income and education, resulting in higher socio-economic inequalities. The article contributes to conceptualisation of the political determinants of health as health policy outputs and a better understanding of the relations between policy outputs and population health outcomes.

South Australia's Rural Health Workforce Strategy 2018-22

The Rural Health Workforce Strategy for South Australia was developed through a comprehensive codesign approach. The workforce plans address individual professions. Implementation of each plan is occurring across all regional Local Hospital Networks.

RURAL & REMOTE MEDICAL SERVICES (RARMS) - A guide to assist rural communities to design and implement an innovative approach to recruiting doctors and strengthening medical services

Rural and remote communities experience a chronic shortage of general practitioners which contributes to higher rates of preventable illness, avoidable hospitalisation and deaths compared to residents of major cities. This is a step by step guide to implementing the Rural and Remote Medical Services model implemented by the Foundation in various rural and remote communities under the name RARMS in 2001.

Defining Value-Based Healthcare in the NHS

The paper examines the concept of ‘Value Based Care’, a principle that has been widely adopted in Australia and which underpins the rationalisation and centralisation of health care. It is a way of managing health services in the context of a system facing increased demand for services with limited resources. However, the authors note that there is an absence of an agreed definition of ‘value-based healthcare’ in the UK National Health Service, and a lack of skills required to deliver value-based healthcare and a clear understanding of the barriers to effective development and implementation inhibits the health system in addressing problems such as overdiagnosis, too much medicine, poor allocation of resources and the introduction of inadequately evidenced technologies This report sets out a route to defining value-based healthcare in the NHS, an assessment of the barriers to its development, and an understanding of what skills and training would support implementation.

Regional Economic Impact of Public Hospital Investment

The value of hospitals to their communities extends far beyond healthcare. In NSW, local health districts provide vital public hospital and health services to around 2.8 million people living in regional and rural areas. Of the $2.89bn capital works program in 2019-20, more than $900m is allocated for capital infrastructure investment in rural and regional NSW. The research has provided an evidence base about the economic impacts of hospital redevelopment. The case study findings support:
• There is a strong connection between public and private investment in healthcare;
• Investment in public health infrastructure leads to flow on growth in health jobs (both in hospitals and other allied health services, and in public and private sectors); and
• Healthcare is a significant growth employment area across all skill and wage levels ... and plays a key role in overall employment.

Evidence Brief: Effects of Small Hospital Closure on Patient Health Outcomes

The United States Veterans Health Administration (VHA) developed evidence brief evaluating the size thresholds needed for small general medical/surgical hospitals to maintain safe and high-quality care by comparing small hospitals with larger ones. The evidence brief found that closing small hospitals in rural areas can increase travel time to the nearest facility, while patients in urban areas are less likely to experience increases in travel time after an urban hospital closure A recent study conducted simulations of closures of nine Japanese hospitals serving patients requiring hemodialysis. Five rural public hospitals and four urban public hospitals were chosen for the model. The model simulated the closure of each rural hospital, each urban hospital, all rural hospitals, all urban hospitals, and shifting capacity of the urban hospitals to the rural hospitals. Simulation results showed that if public hospitals in rural areas were closed, the equity of commuting times among patients worsened much more than if urban public hospitals of similar capacity were closed. Closing of even the smallest rural facility (total capacity 15) affected equity of commuting times more than closure of the large urban hospitals. In a study of hospital emergency department closures in California, including 785,385 patient records, only a small proportion of patients (10% of the sample) experienced an increase in distance to the nearest emergency department as a result of a urban hospital closure, and among them, most had less than a one-mile increase. Another U.S. study looked at the effect of increased driving time to the nearest emergency department over a 10-year period (1995-2005). Patients who experienced the largest increases in driving time were mostly in rural communities. These patients also had more limited access to other hospitals, with the average number of hospitals within a 10-mile radius only 1.03 compared to 2.57 in the control group.

Impact of rural hospital closures on hospitalizations and associated outcomes for ambulatory and emergency care sensitive conditions

The purpose of this paper is to examine the impact of rural hospital closures on age-adjusted hospitalisation rates for ambulatory care sensitive condition (ACSC) and emergency care sensitive condition (ECSC) and associated outcomes, such as length of stay and in-hospital mortality in hospital service areas (HSAs) that utilized the closed hospital. Rural hospital closures were associated with increase in ambulatory care sensitive condition admissions right before closure and for nearly 2 years post closure as well as decrease in emergency care sensitive condition admissions before closure. As rural hospitals continue to close, efforts to ensure communities affected by these closures maintain access to primary health care may help eliminate increases in costly preventable hospital admissions for ambulatory care sensitive condition while ensuring access for emergency care services.

Understanding the impacts of rural hospital closures: A scoping review

Rural hospitals in the United States are closing at unprecedented rates, with hundreds more at risk of closure in the coming 2 years. Multiple federal policies are being developed and implemented without a salient understanding of the emerging literature evaluating rural hospital closures and its impacts. We conducted a scoping review to understand the impacts of rural hospital closure to inform ongoing policy debates and research.

Changes in economic outcomes before and after rural hospital closures in the United States: A difference-in-differences study

The objective of this study is to assess changes in local economic outcomes before and after rural hospital closures.

The Effect of Rural Hospital Closures on Community Economic Health

Hospitals are generally considered to be the locus of rural health care systems. Not only are important health services based at hospitals, but many of a community's health care personnel are either directly employed by or supported by the local hospital. Further, hospitals are often considered vital to local economies as they bring outside dollars into the communities via third-party payors, provide jobs, stimulate local purchasing, and help attract industry and retirees (Doeksen et al. 1997). As such, the closure of a hospital can have detrimental effects on a rural community. The rapid succession of hospital closures throughout the 1980s and 1990s helped stimulate legislation, such as creation of Critical Access Hospitals (hospitals that accept certain restrictions and are reimbursed 101 percent of cost from Medicare), designed to ensure the financial viability of small rural hospitals.

The Economic Impact of Hospitals in Rural Communities

This article presents how to assess the economic impact of a hospital on a rural community. The economic impact is identified by assessing the direct, induced, and indirect impacts that result because of the presence of a hospital in a rural community. The methodology utilizes survey data and estimation procedures for four rural hospitals. The economic impact estimates are based on microdata. Income multipliers are estimated for each of the rural communities. The research demonstrates that rural hospitals do make significant economic contributions to the communities they serve. Community leaders can use the model presented to evaluate the economic impact of their local hospital.

Health Workforce Locator - Doctor Connect

The locator shows the health workforce classification and geographical information of any area.

You can see the workforce classifications:
Distribution Priority Area (DPA)
District of Workforce Shortage (DWS)
Modified Monash Model
The Australian Statistical Geography Standard - Remoteness Area
The Australian Standard Geographical Classification - Remoteness Area
Rural, Remote and Metropolitan Areas

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