Social provision and service delivery: Problems of equity, health, and health care in rural Australia

A neglected area of Australian geographical research relates to the issue of how to ensure an equitable provision of services to inhabitants of rural areas. Equity, however defined, is a procedural concept, requiring the implementation of rules about how to allocate and distribute scarce resources. Equity, as a distributional principle, is an important consideration both in determining the actual amount and nature of resources available and in deciding who will get how much of what is available. Compared with other social goods, there is a particular insistence on equity with respect to health care services. This article outlines the problems characterizing health care provision in rural Australia. It evaluates fiscal equalization as one means by which the Federal Government attempts to ensure at least some equity in the provision and distribution of health care resources to areas of dispersed population. The findings reveal that fiscal equalization alone is unable to ensure equity. This is because of problems of how to assess the needs for and costs associated with providing health care services in areas of dispersed population, confusion between equality and equity, problems related to the differentiation of government functions in a federal system, and inadequacies associated with using hospital services as the basis for resource allocation. This article concludes that equity is more likely to be achieved when policy is oriented to health care rather than medical care and when provision and distribution of resources relates more to service outcomes than to service inputs.