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

Appendix A: Background paper provided to stakeholders

Page last updated: 28 February 2012

Evaluation of the Medical Specialist Outreach Assistance Program and Visiting Optometrists Scheme, 2011


Background information for stakeholder consultations

The Department of Health and Ageing (DoHA) has engaged Health Policy Analysis Pty Ltd (www.healthpolicy.com.au) to conduct an evaluation of the Medical Specialist Outreach Assistance Program (MSOAP), including the program extensions, and the Visiting Optometrists Scheme (VOS).

MSOAP and VOS are two important programs that have been implemented to overcome some specific barriers faced by people living in rural and remote Australia. They facilitate access to medical specialist, optometry and other services for people living in these communities. They have been implemented in a context where a range of other initiatives and programs have been established to address similar or related objectives.

Terms of reference for the evaluation

The purpose of the evaluation is to analyse the efficiency, effectiveness and value of both programs. Areas that will be examined include administrative processes, data collection and management, costs and benefits of services provided, and integration of planning and delivery of rural and remote health services.
The main objectives in undertaking the review are to:
  1. Identify opportunities for improving the coordination of services between the two outreach programs.
  2. Look for opportunities to streamline administration of the programs.
  3. Examine the potential impact of the Health Reform Agenda on both programs.
  4. Determine whether the model of service delivery under each program is effectively, efficiently and equitably meeting the needs of the client groups and other stakeholders.
Key questions to be addressed through the evaluation include:
1. Is MSOAP (including its expansions) effective in providing medical specialist and allied health outreach services is Australian Standard Geographical Classification (ASGC) Remoteness Areas (RAs) 2-5? Issues to be examined include:
    1. challenges to growth in service delivery
    2. costs and benefits (including social benefits to communities) of the program in a sample of communities across the ASGC-RAs
    3. the role of advisory fora
    4. planning processes for identifying needs and ensuring services are put in place.
    5. appropriateness of information available to fundholders and advisory fora to make informed decisions?
    6. recruitment and retention of medical practitioners and other service providers
    7. alternatives means of delivering outreach services
    8. alternatives to address the barriers to outreach delivery and the budget impact of these alternatives
    9. the potential role of team based services within the program
    10. appropriateness and efficiency of data collection and management for the program.
    11. efficiency of MSOAP project administration.
    2. Is VOS effective in providing outreach optometric services in ASGC-RA2-5? Issues to be examined include:
      1. challenges to growth in service delivery
      2. linkages with state/territory based spectacle subsidy schemes
      3. continuity of care for patients between the scheme program and other programs
      4. patient referral processes
      5. planning processes for identifying needs and ensuring services are put in place.
      6. recruitment and retention of optometrists.
      7. alternatives means of delivering outreach services
      8. alternatives to address the barriers to outreach delivery of optometry services and the budget impact of these alternatives.
      9. appropriateness and efficiency of data collection and management for the program.
      10. efficiency of VOS project administration.

    Evaluation methodology

    The evaluation is being conducted through four stages, involving 10 discrete steps. The evaluation commenced in late April 2011 and will be completed by 26 August 2011. The evaluation of the programs will be undertaken through analysis of qualitative and quantitative information. Key methods through which evidence will be gathered for the evaluation include:
      • review of program documentation and associated literature
      • interviews with key stakeholders nationally and in all jurisdictions
      • a survey of clinical service providers who have been supported through MSOAP or VOS
      • analysis of program and related data
      • visits to a sample of rural and remote communities where the impact on access for services will be assessed along with other social impacts of the programs.

    Stakeholders to be interviewed

    Top of pageDoHA has requested that Health Policy Analysis consult with a range of key stakeholders for both MSOAP and VOS. The consultations are to be held between late May 2011 and early July 2011. Stakeholders will be interviewed in all jurisdictions through a mix of face to face and telephone interviews. In addition to interviews, stakeholders may wish to provide a written submission to the evaluation team (see details below).

    Questions for stakeholder interviews

    Questions to be explored with stakeholders include the following:
    Assessment of need: To what extent are processes undertaken by advisory fora and others effective and appropriate in identifying areas of need? How could these processes be improved? Are there lessons from some jurisdictions that could be applied elsewhere?

    Development of service proposals: What have been the processes that have been undertaken to develop service proposals and/or invite service providers to submit service proposals? What approaches have been most successful in eliciting proposals for areas of need?

    Assessment and approval of service proposals: How effective and appropriate are the processes adopted for assessing proposals by fundholders and advisory fora? Could the criteria and scoring approaches be improved? What is the most appropriate time period for reassessing and approving existing service proposals? What advantages and issues would there be in moving from an annual to a multi-year approval cycle?

    Administration of payments to service providers and associated reporting requirements: In what ways could the administrative processes associated with submitting claims and reports be improved and streamlined for service providers, fundholders and DoHA?

    Contractual arrangements between DoHA and MSOAP fundholders: What are the key cost drivers in administering the programs for fundholders? What are the key cost drivers in managing the programs for DoHA? In what ways could administrative costs be reduced with a redesign of the program? Could reporting under MSOAP be more effective without increasing costs?

    Data management: How could data reported be enhanced to provide better information on program effectiveness? How could data flows and reporting be more efficient for service providers, fundholders and DoHA?

    Program effectiveness: How effective have MSOAP and VOS been in improving access for patients in rural and remote areas to specialist medical care, optometry and associated services? What have been other benefits in addition to facilitating greater access to services?

    Does the allocation of services/funding/expenditure across jurisdictions and remoteness areas reflect relative needs? What factors have impacted the distribution of spending under the programs?

    What issues contribute to service providers not being able to deliver the level of service originally planned? How could the programs be redesigned to minimise this problem?

    What are the major opportunities to better integrate arrangements for services funded under MSOAP and VOS?

    What are the major opportunities to improve the operation and effectiveness of MSOAP and VOS?

    Program cost effectiveness: How does the cost of supporting improved access through MSOAP and VOS compare with potential alternative methods of improving access? What are the opportunities to improve value for money under MSOAP and VOS?

    Written submissions to the evaluation

    Interested parties may wish to provide a written submission in relation to the evaluation. These should be submitted by either mail or email by Friday 15 July 2011 as follows:

    Contact information

    If you have any further questions about this project, please contact:
        Deniza Mazevska
        Associate Director
        Health Policy Analysis Pty Ltd
        Phone: (02) 8065 6491
        Mobile: 0413 387 586
        Email: dmazevska@healthpolicy.com.au
    The DoHA project manager is:
        Fiona Brooke
        Director, Rural Outreach Services Section, Rural Health Services and Policy Branch
        Department of Health and Ageing
        Phone: 61 2 6289 7291
        Mob: 0401 712 775
    Email: Fiona.brooke@health.gov.au
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