Final Report on RREF 2001 - Department of Health

Additional costs of service delivery in rural areas
While the rurality weighting in the current RREF was intended to address costs associated with
delivery of services to clients living in rural and remote areas, it has proved to be a “catch 22”.
Participants in the consultations pointed out that additional funding through the RREF led to
increased performance targets at the same unit price, and so was an ineffective means of
recognising higher costs per unit of service delivered. There was also some debate as to the
overall balance of different cost factors in rural and metropolitan regions. Given that an
analysis of cost differences carried out by DHS in preparation for the introduction of unit
costing in 1998 produced ambivalent results about cost differentials between rural and
metropolitan areas, there was seen to be a need to update that work.
A revised RREF would take account of need factors in addition to rurality that affect the volume
of service need, but would not address other factors that affect the cost of service delivery in
rural areas. Factors relating to scale of service operation may be more appropriately addressed
by service development strategies that bring providers together, for example, to share
information technology and staff training, than through the RREF. In any measures to address
travel costs, it was considered important to separate clients who lived in major rural centres and
larger towns from “distant” clients so that any supplementary measures could be targeted to
meeting the extra costs of service delivery to the latter group.
A related issue concerned the need to ensure access to region-wide services, but which could not
deliver at the same level to all local areas. This uneven access is partly a matter of funding
matter but also relates to service development and planning.
Service development grants for special needs groups
Koori services
Provision of services to Koori clients can mean increased costs where relatively
small scale Koori specific agencies have catchment areas that extend across
several LGAs, and even across regional boundaries, whether in rural or
metropolitan areas. This scale factor is similar to the issues affecting service
availability for remote clients, and can result in workers from small agencies
seeing only a few clients per day. Other issues affecting delivery of services to
Koori clients, whether by Koori specific agencies or other agencies, such as
awareness of family roles in Koori culture and recruitment and training of
Koori staff, could be further addressed through continuing the kinds of service
development initiatives that have already been undertaken.
Services for culturally diverse client groups
Delivery of services to culturally diverse client groups was also seen to carry
additional costs, such as provision of interpreter services, for general HACC
agencies that serve large numbers of clients from particular non-English
speaking backgrounds. Service development grants are again a means of
promoting strategies that can enhance the capacity of general agencies to meet
the needs of these clients. Such strategies include closer liaison with ethnospecific
providers to foster provision of more culturally appropriate services
wherever possible, recruitment of staff from relevant cultural backgrounds and
for training of all staff. However, where numbers of particular groups are small
and/or no workers of the same cultural background as the client are available,
the requirement for access to interpreter services needs to be recognised.
Part D: Achieving Equity in the HACC Program
<strong>Final</strong> <strong>Report</strong> July 2001 84