Degree type
PhD
Closing date
1 June 2024
Campus
Hobart
Citizenship requirement
Domestic
About the research project
The Inverse Care Law was first coined by Dr Julian Tudor-Hart, a Welsh general practitioner who observed and described the inequities that existed in healthcare access and health outcomes in his disadvantaged community. He also recognised the importance of the social, economic, environmental and political determinants of health which lead to systematic differences in health. In 1971, he published his seminal paper in the Lancet, outlining the Inverse Care Law which proposes that the 'availability of good medical care tends to vary inversely with the need of the population served.' The Inverse Care Law operates more completely where healthcare is more exposed to market forces and less so when exposure is to market forces is less. This results in underserving those individuals who have the greatest levels of need and overservicing those with the lowest levels of need. This is inequitable and not sustainable. Health is complex and healthcare is only one of the determinants of health, with most studies in agreement that healthcare is responsible for less than half of our health with estimates between 15 and 43%. As important are the social determinants of health which are the factors outside of health care that influence health. These are defined by the World Health Organisation as the 'Conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies, and political systems.' Little progress has been made in both measuring the Inverse Care Law and in addressing it so that more resources are appropriately targeted towards those with greatest need. This inaction contributes to exacerbation of existing inequities in health by failing to provide adequate care for those at greatest risk of poor health outcomes. This in turn leads to increasing demand upon the healthcare system – failure demand, which arises through poor health outcomes which could have been prevented, iatrogenic harm and consumption of resources that could have been used elsewhere.
The Inverse Care Law has been predominately discussed in relation to the provision of primary care and a number of initiatives have developed to address the issues of inequitable access to primary care including the Deep End General Practice Initiative. This initiative has expanded internationally including to Australia with a Deep End General Practice has been established in Canberra. The original premise behind the Inverse Care Law concerned access to primary care because universal access to secondary care was provided through the National Health Service in the UK. In Australia, given reliance on privately funded health care, the Inverse Care Law arguably applies across the whole health system. Socioeconomic disadvantage and cost thus likely a barrier to accessing both primary and secondary care for non-urgent and elective reasons.
In Australia the measurement and monitoring of inequalities in health, determinants of health including social, cultural and economic determinants and access to health systems, is challenging for several reasons. 1. the complexity and fragmentation of the Australian health data landscape and 2. Lack of robust data to inform planning and commissioning of services.
Given the importance of addressing the Inverse Care Law in both primary and secondary care and more adequately aligning the provision of health care with health care needs, there is an imperative to measure, monitor and mitigate the Inverse Care Law through explicit policy, and to develop transparent and accountable processes to plan and commission health services according to need. In the absence of adequate data at both a federal and state level that supports this imperative, there is a need to explore the feasibility of developing a multi-criteria model building on existing data, evidence and stakeholder opinion.
The aim of this research study is to develop a model that explicitly aims to increase equity of health service provision, and which can be used to assess and monitor the Inverse Care Law and to inform policy and planning.
The stages proposed include:
1. Review of the literature on the Inverse Care Law, healthcare access and disparities and the data required to assess and monitor the Inverse Care Law as well as models and frameworks that have been developed both nationally and internationally.
2. Scoping and analysis of data collated in Australia relevant to the Inverse Care Law, comparison with other health systems and identification of gaps in data availability or collection.
3. Stakeholder Engagement and Expert Consultations including healthcare providers, policymakers, community organizations, and patient advocacy groups.
4. Collection and analysis of patient demographic data and healthcare utilisation data to explore and quantify the Inverse Care Law in Australia across areas agreed through consultation and engagement.
5. Develop and test the feasibility of a multicriteria model using routinely available data and expert/ community opinion to inform planning of health services to address need.
6. Develop policy recommendations to improve planning and commissioning of services.
Primary Supervisor
Meet Dr Kate MacintyreFunding
Applicants will be considered for a Research Training Program (RTP) scholarship or Tasmania Graduate Research Scholarship (TGRS) which, if successful, provides:
- a living allowance stipend of $32,192 per annum (2024 rate, indexed annually) for 3.5 years
- a relocation allowance of up to $2,000
- a tuition fees offset covering the cost of tuition fees for up to four years (domestic applicants only)
If successful, international applicants will receive a University of Tasmania Fees Offset for up to four years.
As part of the application process you may indicate if you do not wish to be considered for scholarship funding.
Other funding opportunities and fees
For further information regarding other scholarships on offer, and the various fees of undertaking a research degree, please visit our Scholarships and fees on research degrees page.
Eligibility
Applicants should review the Higher Degree by Research minimum entry requirements.
Ensure your eligibility for the scholarship round by referring to our Key Dates.
Additional eligibility criteria specific to this project/scholarship:
- Applicants must be able to undertake the project on-campus
Selection Criteria
The project is competitively assessed and awarded. Selection is based on academic merit and suitability to the project as determined by the College.
Additional essential selection criteria specific to this project:
- The project will suit an applicant with training in Public Health, Medicine, Policy. Health Economics, Health and Social Sciences, or a Health-related field. It would suit applicants who have a focus on social justice and equity as well as a desire to work collaboratively with consumers, health professionals and community.
Application process
- Select your project, and check that you meet the eligibility and selection criteria, including citizenship;
- Contact Dr Kate Macintyre to discuss your suitability and the project's requirements; and
- In your application:
- Copy and paste the title of the project from this advertisement into your application. If you don’t correctly do this your application may be rejected.
- Submit a signed supervisory support form, a CV including contact details of 2 referees and your project research proposal.
- Apply prior to 1 June 2024.
Full details of the application process can be found under the 'How to apply' section of the Research Degrees website.
Following the closing date applications will be assessed within the College. Applicants should expect to receive notification of the outcome by email by the advertised outcome date.
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