Rural Health Service Delivery

The health profile and demographic characteristics have significant ramifications for the delivery of healthcare and healthcare practice. One approach to equalizing the health outcomes between rural and urban areas has been to develop unique primary healthcare models. These models aim to accommodate the shared characteristics of rurality and remoteness and demographic and health profile attributes.

Factors impacting on healthcare delivery

It is useful to consider the factors that must be accommodated within healthcare delivery. Put another way, what are the factors impacting on the effectiveness of conventional delivery models? Some of the most pressing concerns include:

• Workforce supply: Following the maldistribution of practitioners to urban areas, the per-person supply of practitioners decreases with increasing rurality and remoteness.
• Geographic isolation: The sparsely populated and distributed rural and remote population translates to long distances between key service centres.
• Capital costs: Establishing and maintaining infrastructure in rural and remote areas is quite costly.

Innovative Primary Healthcare Models

In light of these factors, what kinds of primary healthcare models have been developed? A recent systematic review found five different types of models:

• Discrete Services: A single practitioner, such as a general practitioner, is supported in providing healthcare to a local community by a third party that takes responsibility for practice ownership and management.
• Integrated Services: This model provides a single point of access to a range of health services and health practitioners. An example of this model is the Multi-Purpose Services (MPS) program.
• Comprehensive Primary Health Care Services: Some Aboriginal Community Controlled Health Services are an example of this model where an expanded scope of services also aim to address underlying determinants of health.
• Outreach Services: This model describes situations where services are provided from one location to another periodically. This type of model is often referred to as a ‘hub-and-spoke’ model.
• Virtual Outreach services: This model uses technology-assisted measures to overcome long distances and a lack of healthcare professionals. Examples of these models include programs such as telehealth.