Commissioning health services for First Nations, regional, and remote populations: a scoping review
Bibliographic record
Abstract
BACKGROUND: Commissioning for health services has been implemented as one approach to improve the quality and access to healthcare for First Nations, regional and remote populations. This review systematically scoped the literature for studies that described or evaluated the governance, funding, implementation and outcomes from health service commissioning targeting these groups in Canada, Australia, Aotearoa/New Zealand and the United States (CANZUS nations). METHODS: Seventeen databases were searched for relevant peer reviewed and grey literature studies published in English from 2010 to 2023. Grounded theory methods were used to identify the enablers and strategies or processes that support commissioning and any challenges to implementation. RESULTS: Overall, 29 Peer reviewed and 18 grey literature studies remained after screening. The studies reported enabling conditions for effective commissioning including operating models that were responsive to beneficiary needs, workforce and technical capability, flexibility and duration of contracts, adequate funding, and achievable health outcomes and indicators. Supporting strategies focussed on multi-actor collaboration, relationship building, and service innovation. Reported impacts included improved access to care, and self-determination and wellbeing for First Nations populations. Challenges related to inflexible funding, high transaction costs, overcompliance, and poor relationships. Most studies were process evaluations or descriptions of the application of commissioning to various health areas, with comparatively limited assessment of the impacts across the health system, or on health status. CONCLUSION: Findings suggests that a relational model drives success in commissioning for health and wellbeing services for First Nations, regional and remote populations. The relational model presented in this review is supported by the following attributes: responsive, resourced, collaborative, equitable, innovative and self-determined: and when applied by multiple actors in the commissioning process can address the complex health and wellbeing needs of end users.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.061 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.016 | 0.020 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.006 | 0.004 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".