Powerpoint presentation presented at the ANZCOS / AFRM Conference, Brisban

Dawber, James P

Green, Janette P

Simmonds, Frances D

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Simmonds, Frances

Dawber, James

Green, Janette

Research Online

University of Wollongong Research Online Australian Health Services Research Institute Faculty of Business and Law 2011 Equity of access to rehabilitation services in Australia Frances Simmonds University of Wollongong, francess@uow.edu.au James Dawber University of Wollongong, jpd551@uowmail.edu.au Janette Green University of Wollongong, janette@uow.edu.au Follow this and additional works at: https://ro.uow.edu.au/ahsri Recommended Citation Simmonds, Frances; Dawber, James; and Green, Janette, "Equity of access to rehabilitation services in Australia" (2011). Australian Health Services Research Institute. 408. https://ro.uow.edu.au/ahsri/408 Research Online is the open access institutional repository for the University of Wollongong. For further information contact the UOW Library: research-pubs@uow.edu.au Equity of access to rehabilitation services in Australia Keywords equity, services, australia, access, rehabilitation Publication Details F. Simmonds, J. Dawber & J. Green, Equity of access to rehabilitation services in Australia (Centre for Health Service Development, Australian Health Services Research Institute, Wollongong, Australia, 2011). This report is available at Research Online: https://ro.uow.edu.au/ahsri/408           Equity of Access to Rehabilitation Services in Australia                      Centre for Health Service Development   July 2011    Equity of Access to Rehabilitation Services in Australia Equity of Access to Rehabilitation Services in Australia Equity of Access to Rehabilitation Services in Australia Equity of Access to Rehabilitation Services in Australia Equity of Access to Rehabilitation Services in Australia Equity of Access to Rehabilitation Services in Australia Equity of Access to Rehabilitation Services in Australia Equity of Access to Rehabilitation Services in Australia Equity of Access to Rehabilitation Services in Australia Equity of Access to Rehabilitation Services in Australia Equity of Access to Rehabilitation Services in Australia Equity of Access to Rehabilitation Services in Australia Equity of Access to Rehabilitation Services in Australia Equity of Access to Rehabilitation Services in Australia Equity of Access to Rehabilitation Services in Australia Equity of Access to Rehabilitation Services in Australia Equity of Access to Rehabilitation Services in Australia Equity of Access to Rehabilitation Services in Australia Equity of Access to Rehabilitation Services in Australia Equity of Access to Rehabilitation Services in Australia Equity of Access to Rehabilitation Services in Australia Equity of Access to Rehabilitation Services in Australia Equity of Access to Rehabilitation Services in Australia Equity of Access to Rehabilitation Services in Australia Equity of Access to Rehabilitation Services in Australia Equity of Access to Rehabilitation Services in Australia Equity of Access to Rehabilitation Services in UNIVERSITY OF WOLLONGONG   Frances Simmonds James DawberJanette Green  Suggested citation  Simmonds F, Dawber J, & Green J (2011) Equity of Access to Rehabilitation Services in Australia.  Centre for Health Service Development, University of Wollongong    Centre for Health Service Development    Equity of Access to Rehabilitation Services in Australia  Table of Contents  KEY MESSAGES ............................................................................................................................................. 1 1  SCOPE OF PROJECT.......................................................................................................................... 2 2  INTRODUCTION................................................................................................................................... 2 3  METHODS ............................................................................................................................................ 4 4  RESULTS.............................................................................................................................................. 6 4.1  Study Data & Demographics--------------------------------------------------------------------------------------------- 6 4.2  Facility Socioeconomic Status and Remoteness Demographics ----------------------------------------------- 9 4.3  Residential Socioeconomic Status and Remoteness Demographics ---------------------------------------- 11 4.4  Utilisation of Rehabilitation --------------------------------------------------------------------------------------------- 12 4.4.1  Impact of Socioeconomic Status and Remoteness .................................................................... 13 4.4.2  Impact on Length of Stay ............................................................................................................ 17 4.4.3  Impact on Functional Improvement............................................................................................. 19 4.5  Travel Distance as a proxy for accessibility ------------------------------------------------------------------------ 21 5  DISCUSSION...................................................................................................................................... 25 5.1  Limitations of this study ------------------------------------------------------------------------------------------------- 26 6  IMPLICATIONS................................................................................................................................... 27 REFERENCES................................................................................................................................................ 28   Centre for Health Service Development                  Equity of Access to Rehabilitation Services in Australia  List of Tables  Table 1 Socioeconomic categorisation of postal areas using SEIFA............................................................................ 5 Table 2 Number of episodes by impairment and public/private .................................................................................... 6  List of Figures  Figure 1  Study data – number of episodes by impairment and public/private ............................................................ 7 Figure 2  Study data – number of episodes by age grouping...................................................................................... 7 Figure 3 Study data – number of facilities by public/private ....................................................................................... 8 Figure 4 State/territory of patient by state/territory of facility ...................................................................................... 8 Figure 5 Facilities by socioeconomic status ............................................................................................................... 9 Figure 6 Facilities by socioeconomic status and public/private .................................................................................. 9 Figure 7 Facilities by geographic location and public/private ................................................................................... 10 Figure 8 Episodes by socioeconomic status of facility location ................................................................................ 10 Figure 9 Episodes by facility geographic location..................................................................................................... 11 Figure 10 Socioeconomic status by location for Australian population....................................................................... 11 Figure 11 Socioeconomic status by state/territory for Australian population .............................................................. 12 Figure 12 Geographic location by state/territory for Australian population ................................................................. 12 Figure 13 Episodes by state/territory – population proportion vs. episode proportion ................................................ 13 Figure 14 Proportions of episodes by socioeconomic status – expected vs. actual ................................................... 13 Figure 15 Proportion of low/medium/high socioeconomic facility episodes by patient socioeconomic status ............ 14 Figure 16 Proportions of episodes by geographic location – expected vs. actual ...................................................... 15 Figure 17 Patient’s geographic location against socioeconomic status...................................................................... 15 Figure 18 Episodes by patient socioeconomic status by public/private...................................................................... 16 Figure 19 Proportions of public & private episodes by socioeconomic status – expected vs. actual.......................... 16 Figure 20 Episodes by patient location by public/private............................................................................................ 17 Figure 21 Mean LOS by socioeconomic status.......................................................................................................... 17 Figure 22 Mean LOS by socioeconomic status and public/private ............................................................................. 18 Figure 23 Mean LOS by socioeconomic status by impairment grouping.................................................................... 19 Figure 24 Mean FIM change by socioeconomic status .............................................................................................. 19 Figure 25 Mean FIM change by socioeconomic status by public/private ................................................................... 20 Figure 26 Mean FIM change by socioeconomic status by impairment grouping........................................................ 20 Figure 27 Frequency of distances from a patient’s residence to facility ..................................................................... 21 Figure 28 Travel distance by socioeconomic status................................................................................................... 22 Figure 29 Travel distance by state/territory by geographic location ........................................................................... 22 Figure 30 Travel distance by socioeconomic status by geographic location .............................................................. 23 Figure 31 Travel distance by impairment ................................................................................................................... 23 Figure 32 Travel distance by impairment grouping .................................................................................................... 24 Figure 33 Travel distance by age group..................................................................................................................... 24   

Equity of access to rehabilitation services in Australia

University of Wollongong Research Online Australian Health Services Research Institute Faculty of Business and Law 2011 Equity of access to rehabilitation services in Australia Frances D. Simmonds University of Wollongong, francess@uow.edu.au James P. Dawber University of Wollongong, jdawber@uow.edu.au Janette P. Green University of Wollongong, janette@uow.edu.au Follow this and additional works at: https://ro.uow.edu.au/ahsri Recommended Citation Simmonds, Frances D.; Dawber, James P.; and Green, Janette P., "Equity of access to rehabilitation services in Australia" (2011). Australian Health Services Research Institute. 106. https://ro.uow.edu.au/ahsri/106 Research Online is the open access institutional repository for the University of Wollongong. For further information contact the UOW Library: research-pubs@uow.edu.au Equity of access to rehabilitation services in Australia Abstract Powerpoint presentation presented at the ANZCOS / AFRM Conference, Brisbane Keywords services, equity, rehabilitation, australia, access Publication Details F. D. Simmonds, J. P. Dawber & J. P. Green "Equity of access to rehabilitation services in Australia", ANZCOS / AFRM Conference, Brisbane, 15 September 2011, (2011) This conference paper is available at Research Online: https://ro.uow.edu.au/ahsri/106 Equity of Access to h b l  S   Re a i itation ervices inAustraliaFrances SimmondsJ  D bames aw erJanette GreenA t l i  R h bilit ti  O t  us ra as an e a a on u comesCentre (AROC)• AROC is a joint initiative of the Australian rehabilitation sector established in 2002• AROC manages a rehabilitation benchmarking i i i i  i  A li  d N  Z l d h  n t at ve n ustra a an ew ea an w oseultimate aim is the improvement of outcomes for rehabilitation patients  .• To achieve this, AROC requires member rehabilitation services to collect a defined set of data against each and every rehabilitation patient they treat. Introduction• Explore the question, are rehabilitation services equally accessible across Australia?▫ Patients and facilitiesE l i  f t  hi h  ff t lit• xc us on ac ors w c may a ec equa y:▫ Socioeconomic statusR l  ▫ ura or remote▫ Public vs. private rehabilitation serviceM th de o s• Inpatient data for the period 1 July 2009 to 30 June 2010.▫ 70,449 episodes▫ 165 facilities (of 180 nationwide)• How were these exclusion factors measured?• Allocating a socioeconomic status category• SEIFA• Allocating a geographical location category• ASGC-RA• Measuring distancei b d• Tr gonometry ase  on latitude/longitude of centre of postcodesDi ib i   i i  str ut ons across soc oeconom cand geographic levelsP l  h  id  ieop e w o res e n:• higher socioeconomic areas • Major Cities receive proportionally more rehabilitation.National associations between socioeconomic and geographic levels80%90%100%50%60%70%Major Cities of AustraliaInner Regional Australia10%20%30%40% Outer Regional AustraliaRemote AustraliaVery Remote Australia0%Low Medium HighSocioeconomic  statusThere is a clear relationship between socioeconomic status and remoteness, with lower socioeconomic areas being closely associated with regional/remote areas.Distributions of socioeconomic level by public/privatePeople who live in high socioeconomic areas are more likely to access private rehabilitation treatment.Di t ib ti  f f iliti   s r u on o ac es acrosssocioeconomic and geographic levels25303540cilitiesPrivate rehabilitation facilities are more 5101520Number of facPublicPrivatelikely to be found in high socioeconomic areas0Low (n=35, 16) Medium (n=29, 25) High (n=26, 34)Facility scioeconomic  status.And less likely to be f d  l  oun in regiona orremote areas.Di  ll d  h bili i  stance trave e to re a tat onservices70 90061.3344.55405060e (km)500600700800km)Patientsocioeconomicstatus:17.60102030Distance200300400Distance (kLowMediumHigh0Low (n=19674) Medium (n=19420) High (n=28975)Patient socioeconomic  status0100Major Cities of Australia (n=53308)Inner Regional Australia (n=11431)Outer Regional Australia (n=2983)Very/Remote Australia (n=348)People residing in outer regional and remote high socioeconomic areas travel further to access rehabilitation than those in similarly located low socioeconomic areas. Distance travelled by impairment99 17103.8712040 4862.0151.00.60.9243.6353.9890.596080100tance (km).36.11 35.1927.4133.3914.079.9719.6415.5224.0702040DisFor impairments treated largely in specialist units (e.g., brain and spinal injury), the central locations of these services drives some of the differential in travel distance. Additional information• LOS was different between socioeconomic levels but is because of public/private discrepancies• No significant differences in FIM change between socioeconomic levels• Average travel distance to access rehabilitation services varied considerably across different impairmentsA  l di    • verage trave stance to accessrehabilitation services decreased as age increasedConclusion• The main finding of the study is that access to rehabilitation in Australia is inequitablePeople in lower socioeconomic areas▫▫ People in regional and remote areas• Access to public and private rehabilitation services differ across socioeconomic and geographic locations▫ People residing in high socioeconomic areas are more likely to afford private rehabilitation services. ▫ Also, private rehabilitation services are more likely to be situated in high socioeconomic areas which also increases accessibility.

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Equity of access to rehabilitation services in Australia

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