Unveiling Modified Monash

Wednesday, 2 December 2015

This week saw a successful information session in Canberra on the Modified Monash model approach to the classification of rural and remote communities.

The half-day meeting, organised by the NRHA, attracted over 120 people from various agencies and different parts of Australia. Modified Monash, or MM for short, has been developed by the Commonwealth Department of Health and is already being used in the administration of some of its health workforce programs.

Speakers from the Department of Health, the ABS, the Australian Institute of Health and Welfare (AIHW) and the Independent Hospital Pricing Authority (IHPA) brought their various perspectives to the discussion.

MM was born after a healthy and extensive period of gestation, and is now being cared for assiduously by two of its parental bodies: the Department of Health and the Australian Bureau of Statistics. The AIHW is also supporting its development, with IHPA and other agencies contributing to its upbringing by happily entertaining the youthful MM without formally adopting it as yet.

Basically, MM is a system which adds the population size of a place to its distance from the nearest major centre as a combined measure of its 'rurality' or 'remoteness'. Allowance is made for the shadowing effect of data centres on nearby small rural communities with the precise use of 'buffer zones' around large places.

The NRHA is among those bodies whose work shows that the size of a place has a significant effect, not only on the services available but also on the prevalence of health risk factors.

Speakers from the ABS, IHPA and the AIHW were able to stick to their fairly technical last, dealing with data issues, and the pros and cons of 'geographies' of various descriptions and of the application of MM to other sectors, such as disability services and hospital funding.

Much of the discussion session dealt with various aspects of what might be called policy aspects of the application and use of MM. Will it be adopted for use with a particular other program? Might it help with the design of new programs for targeted access to more specialised health care?

Much of the responsibility for responses to such questions fell, by default, to Paul Cutting, the Department of Health Section Head with the main responsibility as custodian of the model and its further development. Paul won the respect of those at the meeting for the tactful, empathetic and  professional way in which he traversed the topics raised, with deference to his departmental colleagues not present and supportive comments.

At the end of the day it was agreed that MM is another geographic system which will be usefully applied for various purposes. However, mere application of a good classification system would and should never take the place of an evidence-based and common sense approach to decisions about what services or interventions are needed for what purposes and where. The extent of need and the cultural appropriateness of services will always moderate any  average measure of what is and is not sufficient for any particular place.

The work will continue.