Evaluation of the Medical Specialist Outreach Assistance Program and the Visiting Optometrists Scheme

1.2 Structure of the final report

Page last updated: 28 February 2012

This report is presented in the three volumes. Volume 1 is the main evaluation report. Volume 2 includes material related to each of the community case studies and the Tele-Derm case study. Volume 3 includes detailed results from the MSOAP service provider survey and the VOS (optometrists’) survey.
The main report (Volume 1) is structured as follows:

Chapter 2 outlines the methodology for conducting this evaluation. It presents the key evaluation questions and how these have been addressed.

Chapter 3 provides a discussion of the context within which MSOAP and VOS operate, focussing on the challenges for delivering health services in rural and remote communities of Australia. It summarises relevant literature related to rural health services and outreach services and sets out the public policy context for MSOAP and VOS. In this Chapter we also present an analysis of the Medicare data on relative access to specialist and optometry services across metropolitan rural and remote Australia. We describe models and programs specifically designed to improve access to health services for rural and remote populations. We also outline some of the key features of recent national health reforms.

Chapter 4 presents a review of the literature on outreach services.
Chapters 5 to 7 are focussed on MSOAP. Chapter 5 presents information on the origins, legislative base and operational features of the program. We outline the nature of recent expansions of the program. The Chapter presents an analysis of program guidelines and information on how the program is administered, including roles of the central office DoHA, state/territory offices of DoHA and fundholders. A description is provided of how advisory fora have been formed and how they have operated in recent years. We have estimated flows of various administrative processes (e.g. funding agreements, reports) and staff involved in various aspects of the administration of the program. The Chapter also presents information on expenditures under MSOAP, services supported under the program, and estimated unit costs. We estimate the number of patients consultations supported through the program and the impact the program is having on improving access to specialist services.

Chapter 6 presents eight case studies undertaken for this project. Seven of the case studies represent a sample of rural and remote communities across Australia, and examine the issues identified for both medical specialist outreach and optometry outreach for these communities. The final case study is of the Tele-Derm service provided by the College of Rural and Remote Medicine, which is supported through MSOAP funding.
Chapter 7 presents a discussion of each of the evaluation questions related to MSOAP, including the views of stakeholders obtained through interviews, written submissions and responses to the survey of MSOAP supported service providers. For each major issue we present our assessment of the issues, our conclusions and recommendations.

Chapters 8 and 9 are focussed on VOS. Chapter 8 presents information on the origins, legislative base and operational features of the Scheme. The Chapter presents an analysis of program guidelines and information on how the program is administered, including roles of the central office DoHA, state/territory offices of DoHA. A description is provided of how VOS reference groups have been formed and how they operate in the jurisdictions and at the national level. We have estimated flows of various administrative processes (e.g. funding agreements, reports) and staff involved in various aspects of the administration of the program. The Chapter also presents information on expenditures under VOS, services supported, and estimated unit costs. We estimate the number of patients undergoing eye examinations supported through the program and the impact the program is having in improving access to optometry.

Chapter 10 presents a discussion of each of the evaluation questions related to VOS, including the views of stakeholders obtained through interviews, written submissions and responses to the survey of optometrists involved with VOS. For each major issue we present our assessment of the issues, our conclusions and recommendations.

Chapter 11 considers the future of both MSOAP and VOS programs in the context of health reform and the creation of Medicare Locals. We make recommendations on how the programs can be aligned with these developments in the short-medium term, and discuss some of the options for the long term.
Within Volume 1 we have included appendices on the evaluation itself, including background material about the evaluation provided to stakeholders (Appendix A), a listing stakeholders interviewed for the evaluation and community case studies (Appendix B), written submissions received for the evaluation (Appendix C). There are also appendices related to payment rates for certain categories of costs under MSOAP and VOS (Appendix D), the approach we took to assign locations to geographic categories in our analyses of program data (Appendix E), definitions used for analysis of Medicare data (Appendix F) and a fuller description of various classification schemes of remoteness (Appendix G).