IMPROVING EQUITY AND EFFICIENCY IN THE BUSH: A NEEDS-BASED METHOD FOR HEALTHCARE RESOURCE ALLOCATION IN REMOTE COMMUNITIES

ABSTRACT: Outback Australia still exists as a frontier economy, relying on public sector provision of the vast majority of services, including health care. In the Northern Territory (NT), high mortality ratios and hospitalisation rates reflect the poor health status of Aborigines who, in 1990-91, accounted for 25% of the population but 40% of hospital patients and 53% of hospital bed days. Funding for primary health care continues to be based on historical utilisation rates, which perpetuates the existing bias towards the urban hospital sector. Health care expenditure analysis suggests that current expenditure patterns fail to fulfil national goals of equity of access and allocation efficiency (maximisation of health outcomes) for the NT Aboriginal population.
This paper outlines a population needs-based resource allocation formula for remote communities, which takes account of three factors: mortality, cost of remoteness and demographic structure. National per capita health care utilisation data are used as a baseline and an allocation weighting is proposed based on the above three factors. This formula is then applied to a typical remote central Australian community. The cost-benefit implications of this alternative funding strategy are explored.