A review of rural and remote health service indexes: are they relevant for the development of an Australian rural birth index?

Background: Policy informs the planning and delivery of rural and remote maternity services and influences the
perinatal outcomes of the 30 per cent of Australian women and their babies who live outside the major cities.
Currently however, there are no planning tools that identify the optimal level of birthing services for rural and
remote communities in Australia. To address this, the Australian government has prioritised the development of a
rigorous methodology in the Australian National Maternity Services Plan to inform the planning of rural and remote
maternity services.
Methods: A review of the literature was undertaken to identify planning indexes with component variables as
outlined in the Australian National Maternity Services Plan. The indexes were also relevant if they described need
associated with a specific type and level of health service in rural and remote areas of high income countries. Only
indexes that modelled a range of socioeconomic and or geographical variables, identified access or need for a
specific service type in rural and remote communities were included in the review.
Results: Four indexes, two Australian and two Canadian met the inclusion criteria. They used combinations of
variables including: geographical placement of services; isolation from services and socioeconomic vulnerability to
identify access to a type and level of health service in rural and remote areas within 60 minutes. Where geographic
isolation reduces access to services for high needs populations, additional measures of disadvantage including
indigeneity could strengthen vulnerability scores.
Conclusion: Current planning indexes are applicable for the development of an Australian rural birthing index. The
variables in each of the indexes were relevant, however use of flexible sized catchments to accurately account for
population births and weighting for extreme geographic isolation needs to be considered. Additionally, socioeconomic
variables are required that will reflect need for services particularly for isolated high needs populations. These variables
could be used with Australian data and appropriate cut-off points to confirm applicability for maternity services. All of
the indexes used similar types of variables and are relevant for the development of an Australian Rural Birth Index.