Measuring Rurality - RIO2008_BASIC: Methodology and Results

Transcription

1 February 2, 2009 Measuring Rurality - RIO2008_BASIC: Methodology and Results Boris Kralj, PhD Executive Director, Economics & Chief Economist OMA Economics Department

2 Introduction and Background The Rurality Index for Ontario (RIO) was originally developed in , a full report outlining the methodology and results can be found in Kralj (2000) 1. The RIO measure was a response to the need for a continuous and broader measure of rurality, than was available, for policy development purposes. In particular, policies and incentives aimed at physician recruitment and retention. This original methodology was refreshed using the most recently available data in 2004, resulting in the release of the RIO2004 measure. Since 2000, the use of RIO has grown and currently a wide variety of MOHLTC and OMA administered programs use it for determining incentive and/or bonus payment levels. Included are the following programs: Rural Medicine Investment Program, Underserviced Area Program, Locum Program, CME Program, Rural and Northern Physician Group Agreement (RNPGA), Hospital On-Call Program (HOCC), Primary Care: rurality gradient for FHN and harmonized models and hospital premium for rural FHN and harmonized models. Finally, it is OMA policy that RIO be employed as a tool for scaling incentive structures. Given the wide and growing use of RIO and the availability of more recent information (i.e., Census of Canada, municipal amalgamations/boundaries), the OMA Board of Directors recommended a review of RIO in the summer of The bilateral Physician Human Resources Committee (PHRC) was given this task and proceeded to strike a working group to carry out the task. The RIO Review Working Group met between October 2007 and January 2008 to conduct the review. The product of the review was the construction of a new measure of rurality, a new rurality index for Ontario (RIO) RIO2008_BASIC. The use of this new measure has been supported by both the OMA and the MOHLTC. 1 Kralj, Boris (2000). Measuring rurality for purposes of health-care planning: an empirical measure for Ontario. Ontario Medical Review. October

3 Components of RIO2008_BASIC The new RIO, RIO2008_BASIC, consists of three broad components as follows: RIO2008_BASIC = POP+TIME a +TIME b Where, POP = Measure of community population and population density. TIME b = Measure of travel time to nearest basic referral centre. TIME a = Measure of travel time to nearest advanced referral centre. The implicit weights or influence of each component is as follows: POP = 28.6 percent; TIME b = 47.6 percent; TIME a = 23.8 percent This specification represents a measure that is analogous to earlier measures given that it is determined almost solely by geographic factors - distances/travel times. Hence, this measure is expected to remain quite stable or fixed over time. The exact empirical specification for each of these factors is presented in Appendix 1. We see that, as was the case with the original RIO, most factors are a relative measure to the provincial median. A brief overview of each of the components is provided below. POP The availability of many health services is positively or directly related to the size of the population. Also, it is a fact that rural areas are less densely populated than urban areas. As a result rural GP s may have to travel longer distances for house calls or may have responsibility for satellite clinics at large distances from their home community. This component of the RIO awards points, in a linear fashion, to communities with a population lower than 45,000 persons. An additional 5 points can be awarded to communities based on their population density or dispersion relative to the provincial median population density. All population data and population density figures are for 2006 and provided by Statistics Canada. TIME a and TIME b Distance to referral centres is an important element which impacts scope of medical practice, levels of responsibility and on-call, as well as professional and social isolation of practitioners and their families. Issues of transportation and travel times may have particular importance in rural areas. Typically, rural residents have greater transportation difficulties and often travel longer distances to receive health care. Lack - 2 -

4 of adequate public transportation in rural areas also creates a barrier to receiving care. The transportation system available to a community determines its degree of isolation. Rural areas served by high-quality transportation corridors will typically have better access to health services. A well-developed road/highway system creates access for patients to local services and facilitates a referral system that links clinics to hospitals, and small hospitals to larger, tertiary care centres. Basic referral centre is a minimum of Level 2 referral centre as defined by the Provincial Coordinating Committee on Community and Academic Health Science Centre Relations (PCCCAR) [ An Interim Guide for Physician Resource Planning in Ontario,October 1996, page 5-6]. That is a centre with a population greater than 10,000 with the following specialty services; GP/FP, Anaesthesia, Diagnostic Radiology, General Internal Medicine, General Surgery, Obs/Gyno, Orthopaedic Surgery, Paediatrics, and Psychiatry. Advanced referral centre is a minimum of Level 4 referral centre as defined by PCCCAR. Additionally, Winnipeg, Manitoba was included as an advanced referral centre based on input from the OMA Section of Rural Practice. A full listing of basic and advanced referral centres is provided in the table on the following page. Travel times, measured in minutes, were calculated using RouteView (routing and catchment analysis software), based on the quickest route via roads and highways. Routes originated and terminated at the centroid of the CSD. RouteView accounts for four different classes of road, and hence travel speeds. These are; (i) major road with default speed of 60 km/hr, (ii) regional road with default speed of 75 km/hr, (iii) highway with default speed of 90 km/hr, and (iv) expressway with default speed of 100 km/hr. When one combines these travel speeds with travel distances, the travel time measure is arrived at

5 Basic Referral Centre Listing Advanced Referral Centre Listing CSD_number CSD_name CSD_number CSD_name Cornwall Ottawa Ottawa Kingston Brockville Toronto Kingston Mississauga Belleville Hamilton Peterborough Windsor Ajax London Oshawa Greater Sudbury / Grand Sudbury Markham Thunder Bay Richmond Hill n/a Winnipeg, Manitoba Newmarket Toronto Mississauga Brampton Guelph Oakville Burlington Hamilton Welland Niagara Falls St. Catharines Brantford Cambridge Kitchener St. Thomas Chatham-Kent Windsor Sarnia London Owen Sound Barrie North Bay Greater Sudbury / Grand Sudbury Sault Ste. Marie Thunder Bay Timmins - 4 -

6 Exclusions and Final Scoring Using the 2001 Census definitions there are approximately 580 CSDs in Ontario, for purposes of constructing the RIO2008_BASIC measure of rurality approximately 200 CSDs were excluded from the analysis. Specifically, we excluded unorganized areas, Indian reserves and settlements, and CSD s with a population of less than 500. Unorganized Areas (UNO) refers to unincorporated areas, these areas have no legal, political or jurisdictional authority. They are simply areas that do not fall into the area of an incorporated town/city/village/etc.. The inclusion of UNO s results in a great deal of data skewing and as such have been removed from analysis. Additionally, Indian settlements and reserves were excluded from the analysis since Federal government funding (not OHIP) covers medical services provided on Indian Reserves. However, provincial (OHIP) funding covers services provided to native Indians when the services are delivered off the Reserves. Finally, to further minimize any data skewing, communities with populations less than 500 persons were removed from the analysis. Results The overall raw scores for RIO2008_BASIC were transformed to a 0 to 100 scale. These scores were then rounded to the nearest integer. Please remember that these scores are ordinal measures reflecting a relative ranking or rurality, rather then cardinal measures. A higher score reflects a higher degree of rurality. Descriptive statistics on the distribution of CSD RIO2008_BASIC scores are presented in the table below. RIO2008_BASIC N 379 Mean 45.2 Std. Deviation 24.6 Median th Percentile th Percentile 61 Appendix 2 provides a listing of final scores for RIO2008_BASIC by CSD. Appendix 3 provides a map illustrating the distribution of final RIO2008_BASIC scores across the province

7 APPENDIX 1 RIO2008 Empirical Specifications TIME b = Measure of travel time to nearest basic referral centre TIME b = [(T b - T bm ) /T bm ] x 10 If TIME b > 40 then TIME b = 40. where, T b = Minutes of travel time to nearest basic referral centre. T bm = Median travel time = 49.4 minutes. Max. possible score = 40; Min. possible score = TIMEa = Measure of travel time to nearest advanced referral centre TIME a = [(T a T am ) /T am ] x 10 If TIME a > 15 then TIME a = 15. where, T a = Minutes of travel time to nearest advanced referral centre. T am = Median travel time = minutes. Max. possible score = 15; Minimum possible score = -10. POP = [ (P 06 /P M )] + [5 (P D /22.6)] POP = Measure of community population If [ (P 06 /P M )] <0 then set [ (P 06 /P M )] = 0. If [5 (PD/22.6)] <0 then set [5 (P D /22.6)] = 0. where, P 06 = Total population of CSD in P M = Median population of CSDs in 2006 = 6,825 persons. P D = Median population density of CSDs = 22.6 persons/sq.km Max. possible score = 30; Min. possible score =

8 APPENDIX 2: RIO2008_BASIC listing by CSD

9 CSD NUM CSD NAME Type RIO2008_BASIC Addington Highlands TP Adelaide Metcalfe TP Adjala-Tosorontio TP Admaston/Bromley TP Ajax T Alberton TP Alfred and Plantagenet TP Algonquin Highlands TP Alnwick/Haldimand TP Amaranth TP Amherstburg T Armour TP Armstrong TP Arnprior T Arran-Elderslie MU Ashfield-Colborne-Wawanosh TP Asphodel-Norwood TP Assiginack TP Athens TP Atikokan TP Augusta TP Aurora T Aylmer T Baldwin TP Bancroft T Barrie CY Bayham MU Beckwith TP Belleville CY Billings TP Black River-Matheson TP Blandford-Blenheim TP Blind River T Blue Mountains T Bluewater MU Bonfield TP Bonnechere Valley TP Bracebridge T Bradford West Gwillimbury T Brampton CY Brant CY Brantford CY Brighton MU Brock TP Brockton MU Brockville CY Brooke-Alvinston MU 43 OMA Economics Department 1

10 CSD NUM CSD NAME Type RIO2008_BASIC Bruce Mines T Brudenell, Lyndoch and Raglan TP Burk's Falls VL Burlington CY Caledon T Callander MU Calvin TP Cambridge CY Carleton Place T Carling TP Carlow/Mayo TP Casselman VL Cavan-Millbrook-North Monaghan TP Central Elgin MU Central Frontenac TP Central Huron MU Central Manitoulin TP Centre Hastings MU Centre Wellington TP Champlain TP Chapleau TP Chapple TP Charlton and Dack MU Chatham-Kent MU Chatsworth TP Chisholm TP Clarence-Rockland CY Clarington MU Clearview TP Cobalt T Cobourg T Cochrane T Collingwood T Conmee TP Cornwall CY Cramahe TP Dawn-Euphemia TP Dawson TP Deep River T Deseronto T Douro-Dummer TP Drummond/North Elmsley TP Dryden CY Dubreuilville TP Dutton/Dunwich MU Dysart and Others TP Ear Falls TP 100 OMA Economics Department 2

11 CSD NUM CSD NAME Type RIO2008_BASIC East Ferris TP East Garafraxa TP East Gwillimbury T East Hawkesbury TP East Luther Grand Valley TP East Zorra-Tavistock TP Edwardsburgh/Cardinal TP Elizabethtown-Kitley TP Elliot Lake CY Emo TP Englehart T Enniskillen TP Erin T Espanola T Essa TP Essex T Faraday TP Fauquier-Strickland TP Fort Erie T Fort Frances T French River / Rivière des Français M Front of Yonge TP Frontenac Islands TP Galway-Cavendish and Harvey TP Gananoque T Georgian Bay TP Georgian Bluffs TP Georgina T Gillies TP Goderich T Gore Bay T Gravenhurst T Greater Madawaska TP Greater Napanee T Greater Sudbury / Grand Sudbury C Greenstone MU Grey Highlands MU Grimsby T Guelph CY Guelph/Eramosa TP Haldimand County CY Halton Hills T Hamilton C Hamilton TP TP Hanover T Harley TP Harris TP 83 OMA Economics Department 3

12 CSD NUM CSD NAME Type RIO2008_BASIC Hastings Highlands MU Havelock-Belmont-Methuen TP Hawkesbury T Hearst T Highlands East MU Hornepayne TP Horton TP Howick TP Huntsville T Huron East MU Huron Shores MU Huron-Kinloss TP Ignace TP Ingersoll T Innisfil T Iroquois Falls T Johnson TP Kapuskasing T Kawartha Lakes CY Kearney T Kenora CY Killaloe, Hagarty and Richards TP Kincardine MU King TP Kingston CY Kingsville T Kirkland Lake T Kitchener CY La Vallee TP Laird TP Lake of Bays TP Lakeshore T Lambton Shores MU Lanark Highlands TP Larder Lake TP LaSalle T Laurentian Hills T Laurentian Valley TP Leamington MU Leeds and the Thousand Islands TP Lincoln T London CY Loyalist TP Lucan Biddulph TP Macdonald, Meredith and Aberdeen AdTP Machar TP Machin TP 100 OMA Economics Department 4

13 CSD NUM CSD NAME Type RIO2008_BASIC Madawaska Valley TP Madoc TP Magnetawan MU Malahide TP Manitouwadge TP Mapleton TP Marathon T Markham T Markstay-Warren MU Marmora and Lake MU Mattawa T Mattice-Val Côté TP McDougall MU McGarry TP McKellar TP McMurrich/Monteith TP McNab/Braeside TP Meaford MU Melancthon TP Merrickville-Wolford VL Michipicoten TP Middlesex Centre TP Midland T Milton T Minden Hills TP Minto T Mississauga CY Mississippi Mills T Mono T Montague TP Moonbeam TP Morris-Turnberry MU Mulmur TP Muskoka Lakes TP Neebing MU New Tecumseth T Newmarket T Niagara Falls CY Niagara-on-the-Lake T Nipigon TP Nipissing TP Norfolk County CY North Algona Wilberforce TP North Bay CY North Dumfries TP North Dundas TP North Frontenac TP 56 OMA Economics Department 5

14 CSD NUM CSD NAME Type RIO2008_BASIC North Glengarry TP North Grenville MU North Huron TP North Kawartha TP North Middlesex MU North Perth MU North Shore TP North Stormont TP Northeastern Manitoulin and the IslandT Northern Bruce Peninsula MU Norwich TP Oakville T O'Connor TP Oil Springs VL Oliver Paipoonge MU Orangeville T Orillia CY Oro-Medonte TP Oshawa CY Otonabee-South Monaghan TP Ottawa C Owen Sound CY Papineau-Cameron TP Parry Sound T Pelham T Pembroke CY Penetanguishene T Perry TP Perth T Perth East TP Perth South TP Petawawa T Peterborough CY Petrolia T Pickering CY Plummer Additional TP Plympton-Wyoming T Point Edward VL Port Colborne CY Port Hope MU Powassan MU Prescott T Prince TP Prince Edward CY Puslinch TP Quinte West CY Rainy River T 95 OMA Economics Department 6

15 CSD NUM CSD NAME Type RIO2008_BASIC Ramara TP Red Lake MU Red Rock TP Renfrew T Richmond Hill T Rideau Lakes TP Russell TP Ryerson TP Sables-Spanish Rivers TP Sarnia CY Saugeen Shores T Sault Ste. Marie CY Schreiber TP Scugog TP Seguin TP Severn TP Shelburne T Shuniah TP Sioux Lookout MU Sioux Narrows - Nestor Falls TP Smith-Ennismore-Lakefield TP Smiths Falls T Smooth Rock Falls T South Algonquin TP South Bruce MU South Bruce Peninsula T South Dundas TP South Frontenac TP South Glengarry TP South Huron MU South River VL South Stormont TP Southgate TP Southwest Middlesex MU South-West Oxford TP Southwold TP Spanish T Springwater TP St. Catharines CY St. Clair TP St. Joseph TP St. Marys T St. Thomas CY St.-Charles MU Stirling-Rawdon TP Stone Mills TP Stratford CY 23 OMA Economics Department 7

16 CSD NUM CSD NAME Type RIO2008_BASIC Strathroy-Caradoc TP Strong TP Sundridge VL Tay TP Tay Valley TP Tecumseh T Temagami MU Terrace Bay TP Thames Centre MU The Archipelago TP The Nation / La Nation M Thessalon T Thorold CY Thunder Bay CY Tillsonburg T Timiskaming Shores CY Timmins CY Tiny TP Toronto C Trent Hills MU Tudor and Cashel TP Tweed MU Tyendinaga TP Uxbridge TP Val Rita-Harty TP Vaughan CY Wainfleet TP Warwick TP Wasaga Beach T Waterloo CY Welland CY Wellesley TP Wellington North TP West Elgin MU West Grey MU West Lincoln TP West Nipissing / Nipissing Ouest M West Perth MU Westport VL Whitby T Whitchurch-Stouffville T White River TP Whitestone MU Whitewater Region TP Wilmot TP Windsor CY Wollaston TP 60 OMA Economics Department 8

17 CSD NUM CSD NAME Type RIO2008_BASIC Woodstock CY Woolwich TP Zorra TP 36 OMA Economics Department 9

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