Senate committee backs AMA call to scrap flawed rating system
A parliamentary committee has called for the much-maligned classification scheme for country doctor incentives to be scrapped as part of an overhaul of arrangements to boost rural health care. In an outcome hailed by the AMA, the Senate Community Affairs References Committee recommended that the Australian Standard Geographical Classification – Remoteness Area (ASGC-RA) system be discarded and replaced with a scheme that takes account of a broad range of factors including location, population, workforce and professional and social factors in determining the allocation of incentives.
A parliamentary committee has called for the much-maligned classification scheme for country doctor incentives to be scrapped as part of an overhaul of arrangements to boost rural health care.
In an outcome hailed by the AMA, the Senate Community Affairs References Committee recommended that the Australian Standard Geographical Classification – Remoteness Area (ASGC-RA) system be discarded and replaced with a scheme that takes account of a broad range of factors including location, population, workforce and professional and social factors in determining the allocation of incentives.
The change was part of a range of measures suggested by the committee following its 11-month inquiry into factors affecting the supply of health services and medical professionals in rural areas.
The committee found that there were significant disparities in access to vital health services between metropolitan and rural areas despite efforts over many years to address the imbalance.
“Medical specialist numbers plummet outside the major cities, to levels as low as one-sixth of those in the large capitals,” the report said. “Accessibility, particularly in remote areas, is an issue.”
It said that while doctors encountered personal and professional barriers to working in rural areas, including income, professional development, housing and opportunities for spouses and children, allied health professionals faced additional hurdles from restrictive Medicare funding arrangements and lower remuneration, which affected the ability to find affordable and secure accommodation.
AMA President Dr Steve Hambleton said the report echoed many of the issues highlighted in the AMA’s Regional/Rural Workforce Initiatives Position Statement released earlier this year, and underlined the significant problems that people in rural communities faced in obtaining medical services.
Dr Hambleton said the Committee’s findings on the shortcomings of the existing classification system were particularly welcome.
“We are pleased that the Committee has identified the significant weaknesses apparent in the application of the ASGC-RA classification system that underpins Commonwealth programs to support the rural medical workforce, and recommends that it be replaced,” he said.
Dr Hambleton said failings in the system, which is currently under review, resulted in many small rural areas being stuck with the same incentive structures as much larger towns, exacerbating inequities in the distribution of health services.
In its report the Committee warned, “there will never be a perfect model that does not result in some anomalies”.
“However, evidence provided to the Committee during its inquiry did not support the use of the ASGC-RA scheme in its current form as the sole determinant of classifying areas for workforce incentive purposes,” the report said. “Even the evidence in general support of the scheme was heavily conditional on it being augmented with further datasets to provide a more accurate representation of workforce conditions across the country.”
The Committee wrote approvingly of a classification model developed by researchers at the Centre of Research Excellence in Rural and Remote Primary Health Care that based the distribution of incentives more on population and professional considerations than geographical location per se.
In their submission to the inquiry the researchers, led by Professor John Humphreys, recommended the use of a classification system in which “sentinel professional and other factors known to be significantly associated with recruitment and retention are used to guide the eligibility for, and distribution of, incentives”.
“When these workforce factors are examined in relation to population size and geographical remoteness of communities, population size is a more sensitive measure in directing where recruitment and retention incentives should be provided.
“This new six-level geographical classification provides a better basis for equitable resource allocation of recruitment and retention incentives to doctors based on the attractiveness of non-metropolitan communities, both professionally and nonprofessionally, as places to work and live.”
In its report the Committee said it approved the methodology and data utilised by Professor Humphreys and his colleagues, and “would like to see this incorporated into a new scheme”.
The Committee also recommended reforms to teaching and training arrangements, including better incentives for rural GPs providing training for pre-vocational and vocational students and the extension of the HECS Reimbursement Scheme for doctors to nurses and other allied health professionals.
Dr Hambleton said the strong focus of the report on supporting teaching and training in rural areas was important, as was increased efforts to encourage more rural students to study medicine.
“The AMA fully supports these approaches, which need to incorporate appropriately funded incentives rather than the current draconian system of unfunded bonding of students to rural areas,” he said. “Another welcome recommendation is the need to ensure that Government reforms to after hours GP services do not result in funds being withdrawn from general practices that are currently providing after hours services.”
Published: 02 Sep 2012