Final Report on RREF 2001 - Department of Health

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Part B: Development of Options for a Revised RREF Self reported health/well-being was excluded because no data is available at the LGA level from a reliable source. 15 variables remained Health status indicators accounted for five of these. Four of the indicators suggested are essentially alternative measures of aspects of mortality; hence there is a high level of duplication between them, and also with the fifth indicator of excess morbidity. It is appropriate to include only one health indicator for weighting in the RREF and life expectancy was considered the most appropriate variable as it captures the effects of excess morbidity and premature mortality on the dependency and therefore need for HACC services. ⇒Life expectancy to be considered as a need variable 10 variables remained Location factors accounted for a further three variables (retirement villages already being excluded). These were population density, access and rural-urban fringe location, and the Accessibility/ Remoteness Index for Australia (ARIA). The newly developed ARIA is based on actual travel distance from small local areas to population centres of different sizes, and so provides a measure of accessibility rather than just population density or straight line distance. ARIA is a more comprehensive and relevant indicator of need in rural areas than the measure of population density used in the current RREF. It defines 15 levels of access/remoteness across Australia, with Victorian LGAs extending across the first five levels. These five levels give a finer breakdown than the previous three tier rural weighting. ⇒ Accessibility/Remoteness Index for Australia (ARIA) to be considered as a need variable 7 variables remained, one of which was the composite index IRSED IRSED – the Index of Relative Socio-Economic Disadvantage is one of five Socio-Economic Indexes for Australia (SEIFA) and is a composite of 20 variables. IRSED has been developed by the ABS and is widely used in health and community services planning. IRSED is built up from Census data at LGA level and each LGA obtains an IRSED “score” which reflects the interaction of the 20 variables within the LGA. One advantage of IRSED is that it gives a measure of the overall social environment in which residents of any area live rather than just reporting individual data; thus, individuals of any given socio-economic status who live in better off areas will experience less disadvantage than individuals of the same socio-economic status who live in a worse off area because of opportunities afforded by the general social environment. The ABS stresses that IRSED should only be used when its component variables are relevant to the program under consideration. Many of the employment related variables in IRSED may be of less relevance to HACC than to programs providing assistance with training and employment, such as the Commonwealth State Disability Program, and it was considered that aspects of socio-economic status relevant to HACC would be better represented in the RREF by separate variables. For example, cultural diversity and the Koori population were widely recognised as relevant to HACC, but these two variables made relatively little contribution to the IRSED. The preferred option for the RREF is to use separate variables to weight for socioeconomic status, cultural diversity and Koori population. <strong>Final</strong> <strong>Report</strong> July 2001 36
Part B: Development of Options for a Revised RREF 6 variables remained covering four broad dimensions of need. Two variables were indicators of cultural diversity: • fluency in English/speaking a language other than English at home • non-English speaking birthplace. As the correlation between these two variables for LGAs is .99, the choice of one or other will make no difference statistically. As use of a language other than English at home gives a better indicator of the home situation and adherence to culture, and especially the likelihood of needing to use interpreters or staff of the same cultural background in provision of HACC services, it is seen as a more appropriate indicator of cultural diversity. ⇒ Speaking a language other than English at home to be considered as a need variable Three variables apart from the IRSED were indicators of socio-economic status. As well as socio-economic status being an indicator of reliance on HACC services, inclusion of an SES indicator in weighting the RREF was seen as the most appropriate way of taking capacity to pay fees into account. Median household income Public housing Take up of benefits: Disability Support Pension, Child Disability Allowance, full-rate Age Pension As only a small proportion of the population reside in public housing, household income is seen as a more appropriate indicator of socio-economic status as it show a wider range of variation across the whole population. Not only does the household income variable include those with low incomes in public housing but it also includes low income private renters. Further, assets are not taken into account, so rural areas with many households having considerable assets in land but low incomes record low median household incomes. Careful consideration was given to the choice between median household income and a variable based on take up of benefits. The variable to be included needs to be a broad indicator of socioeconomic status, which will also reflect capacity of individuals to pay fees for HACC services or to make choices to pay for alternative services. Five sets of factors have a bearing on the choice of the variable: • Differences in focus. In contrast to the broad eligibility criteria for HACC, the DSP and CDA are both highly targeted through eligibility based on both means testing and disability. Take up of these two benefits identifies a very small population with a high level of need on both these grounds, but this stringent definition excludes those disabled individuals whose parents or partners have income in excess of mean test limits. Inclusion of full-rate Age Pensioners only excludes part pensioners who have some level of handicap and who would pay only limited fees for HACC services. • Eligibility for DSP and CDA is based on handicap, and so eligible individuals are covered by the definition of handicap used in DACS. Research commissioned by the DHS Disability Program reports that DACS data correspond much more closely with the program client population than DSP and CDA beneficiaries. As DSP and CDA are both means tested, there is duplication with income variables. Both also have age limits and other eligibility criteria and so do not cover the whole population consistently. <strong>Final</strong> <strong>Report</strong> July 2001 37
Page 1 and 2: FINAL REPORT REVIEW OF THE RELATIVE
Page 3 and 4: STEP 3: OPTIONS FOR SCALING NEED VA
Page 5 and 6: ABBREVIATIONS AND NOTE ON TERMINOLO
Page 7 and 8: ACKNOWLEDGEMENTS An exercise as ext
Page 9 and 10: EXECUTIVE SUMMARY The Review of the
Page 11 and 12: Executive Summary All regions will
Page 13 and 14: Executive Summary Beyond the detail
Page 15 and 16: Executive Summary 9. The planning a
Page 17 and 18: PART A: BACKGROUND AND SCOPE OF THE
Page 19 and 20: Part A: Background and Scope of the
Page 31 and 32: PART B: DEVELOPMENT OF OPTIONS FOR
Page 33 and 34: Part B: Development of Options for
Page 39 and 40: Final Repo
Page 51: Part B: Development of Options for
Page 59 and 60: Step 4: Options for weighting need
Page 65 and 66: Profiles of Need Variables Part B:
Page 81 and 82: Part C: Outcomes In the initial mod
Page 83 and 84: Part C: Outcomes 5.3 FURTHER ISSUES
Page 85 and 86: Part C: Outcomes Step 6: Outcomes o
Page 87 and 88: Part C: Outcomes • The Northern a
Page 89 and 90: Part C: Outcomes By way of illustra
Page 91 and 92: Part C: Outcomes The outcomes of th
Page 93 and 94: Part C: Outcomes 7.4 FURTHER ISSUES
Page 95 and 96: Four features of the revised outcom
Page 97 and 98: Part C: Outcomes The adjustment for
Page 99 and 100: Part D: Achieving Equity in the HAC
Page 101 and 102: Unit cost structure The unit cost s
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Part D: Achieving Equity in the HAC
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APPENDIX 1.1 continued Commonwealth
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APPENDIX 1.4: SUBMISSIONS RECEIVED
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Frequently Asked Questions A number
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DACS • 2.5% of children in the 0-
Page 113 and 114:
LGA Median H’hold Inc. YLD Lang o
Page 115:
Department of Human Services 1999b.
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Final Report on RREF 2001 - Department of Health

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