Do health and medical workforce shortages explain the lower rate of rural consumers' complaints to Victoria's Health Services Commissioner?

OBJECTIVE: To identify which explanations account for lower rural rates of complaint about health services--(i) fear of consequences where there is little choice of alternative provider; (ii) a higher complaint threshold for rural consumers; (iii) lack of access to complaint mechanisms; or (iv) reduced access to services about which to complain.

DESIGN: Ecological study incorporating consumer complaint, population and workforce distribution data sources.

SETTING: All health care providers practising in Victoria.

PARTICIPANTS: De-identified records of all closed consumer complaints made to the Health Services Commissioner, Victoria, between March 1988 and April 2001 by Victorian residents (13 856 records).

MAIN OUTCOME MEASURES: Differences in the percentage of under-representation in complaint rates in total and for each of four categories of health services providers for different size communities.

RESULTS: No consistent relationship was observed between community size and either degree of under-representation of complaints against any category of provider, or the proportion of serious or substantial complaints. Rural under-representation was highest (41%) for dentists, the provider category with the lowest proportion working in rural areas (17%), and lowest (18%) for hospitals, with the highest representation in rural areas (28% of beds). More rural complaints were about access issues (10.7% rural and 8.4% metropolitan).

CONCLUSIONS: Reduced opportunity to use health services due to rural health and medical workforce shortages was the best-supported explanation for the lower rural complaint rate. Workforce shortages impact on the quality of rural health services and on residents' opportunities to improve their health status.