Abstract
The recent closure of rural health services in many developed countries has been a natural experiment as health planners strategically adopt regionalized systems of care to combat staggering healthcare system costs. Regionalization is predicated on offering health services in selected discrete locations (‘referral centers’) as opposed to in every local community of reasonable size. Where complex, specialistbased care is required, this approach is fiscally sensible, professionally sustainable and leads to good patient outcomes. When the dislocated service falls under the umbrella of ‘primary care’ (those services that in usual circumstances do not require specialist support but instead benefit from a generalist, wholistic model of care), the efficacy of care in referral communities is not as clear. Notions of ‘risk’, both of local care and care in a referral center, is at the heart of this discussion. This phenomenon is perhaps best illustrated with the case of rural maternity care. The purpose of this Editorial is to extrapolate contemporary theories of risk and apply them to a current and pressing health service delivery issue as a way of illuminating their usefulness in framing the discussion.
Highlights
The recent closure of rural health services in many developed countries has been a natural experiment as health planners strategically adopt regionalized systems of care to combat staggering healthcare system costs[1]
During the past decade we have seen the precipitous closure of rural maternity services in Canada[3,4], the USA5, Australia[6], New Zealand[6] and parts of Europe[6,7]
The decision-making process of parturient women privileges social interpretations of risk while physician care-providers are more likely to privilege clinical interpretations[16]. These divergent risk perspectives lead to a parallel discussion marked by conceptual dissonance, often resulting in an impasse: disagreements about whether the parturient woman should leave the community or give birth locally[16]
Summary
J Kornelsen[1], C MacKie2 1University of British Columbia, Vancouver, British Columbia, Canada. Submitted: 3 May 2012; Revised: 23 August 2012, Accepted: 4 December 2012 Published: 12 March 2013 Kornelsen J, MacKie C. Notions of ‘risk’, both of local care and care in a referral center, is at the heart of this discussion. This phenomenon is perhaps best illustrated with the case of rural maternity care. The purpose of this Editorial is to extrapolate contemporary theories of risk and apply them to a current and pressing health service delivery issue as a way of illuminating their usefulness in framing the discussion
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
