Many Commonwealth program allocations are tied administratively, and sometimes legislatively, to a geographical remoteness classification, the Rural, Remote and Metropolitan Areas Classification (RRMA), which identifies seven categories of remoteness according to the population as recorded in the ABS 1991 Census of Population and Housing. These are capital city, other metropolitan centre, large rural centre, small rural centre, other rural area, remote centre and other remote area.
Significant changes in patterns of urbanisation since the adoption of the RRMA have resulted in anomalies in allocations and incentives. Given the large numbers of programs that are determined on the basis of RRMA and the difficulties of reallocation of resources, the Australian Government has a continuing need for information broken down on this basis.
In contrast, the Remoteness Area (RA) structure within the Australian Bureau of Statistics' Australian Standard Geographical Classification (ASGC) is now reported routinely for many national collections, including the labour force surveys. This breaks down geographical regions into five categories ('major cities', 'inner regional', 'outer regional', 'remote' and 'very remote') and is updated to take into account factors such as new road networks, new area boundaries and actual services provided through centres. It is used as a basis for state planning and provides a better basis for understanding workforce projections as it reflects changes in population distribution and urbanisation.
Attachment E provides further information on the two classification systems.
The data sources available to the Department, as described above, have been analysed by state and territory and Remoteness Area, in order to give an indication of how rural and remote Australians are faring in terms of the supply of health professionals, and in particular, which geographical areas of Australia appear to have the lowest proportion of health professionals. Data from Medicare and labour force surveys are not available at the SLA level. So information from the 2006 Census, which is available at this level of disaggregation, was also examined.
It should be noted that ratios of health professionals to populations, particularly when considered by profession, can give a distorted picture of the accessibility of health care to a particular area in that health services are commonly provided to service catchment areas that are contiguous, comprising more than one individual area. An example would be a small community on the outskirts of a major regional centre. Alternatively, geographical barriers, such as mountain ranges and other logistical challenges, can make what appears to be a relatively short distance between areas a considerable barrier to accessing services. An understanding of the service model and professional mix is also necessary when analysing whether a particular catchment area is being serviced adequately. This information is not available at a national level.
Nevertheless, in order to provide the level of detail required for this audit, available national data, primarily on the medical and nursing workforces, has been examined at the local area level where possible.
In addition to the workforce data, a range of Australian Government and state-funded complementary initiatives are directly focussed on locating, financing or supporting health professionals to provide services in rural and remote areas. Data on the distribution of the medical workforce that has been the particular target of Australian Government locational initiatives are also provided in the following section.
There are a range of factors which contribute to the relative under representation of the health workforce in rural and remote areas. In particular, when deciding where they will practise, health professionals will take account of factors such as remuneration, professional and career development and lifestyle in making their choice. Education and training opportunities for health workers in rural and remote areas also have an important impact on workforce availability.
(Productivity Commission report, Australia's Health Workforce)