Establishment of radiation therapy services in North West Tasmania: a community need or election strategy?

BACKGROUND: This case study examines the impetus for policy change that resulted in the establishment of a radiation therapy service in rural North West Tasmania, Australia. Provision of local radiation therapy services improves accessibility for those in rural and regional areas. However, providing these services and maintaining them is not achievable for all areas. The drivers to establish services in more regional locations are not always well understood. This article presents a case study of how a radiation therapy service was established in North West Tasmania. It applies a health policy analysis model (the Advocacy Coalition Framework) to examine the impetus for policy change and draws conclusion about how the framework can be applied to the development of health services in rural areas. Understanding the impetus for policy change allows health service planners to apply this knowledge to influence the health agenda. Knowing the way in which policy change can be driven creates an opportunity to become more strategically involved in policymaking. METHOD: Documents related to the case study were analysed for expressed beliefs, using the Advocacy Coalition Framework, to determine any identifiable coalition of actors that held consistent, shared beliefs and were engaged in non-trivial action to the establish radiation therapy services in North West Tasmania. RESULTS: Document analysis confirmed the presence of a Health Policy Coalition that was concerned about sustainability and safety in establishing the service. No additional coalition was identified. Instead, the possible role of the media and the marginal nature of the local Federal electorate were likely to have impacted the subsequent policy change. CONCLUSIONS: The study found evidence that policy change was achieved primarily as a result of a political strategy designed to win support during a Federal election. This has important implications for health policy in rural areas, especially for those population centres located in marginal seats. During an election cycle the decision to establish new health services may not be wholly influenced by an identified coalition or issue such as sustainability, community needs or rationality.