AbstractA myriad of economic, political and demographic factors continue to propel the “social transformation” of health in America. The healthcare industry has undergone drastic restructuring in the United States (Folland et al, 2001; McLafferty, 2003). During the 1980’s and 1990’s hospital closures, mergers, and reorganizations greatly impacted spatial organization and availability of healthcare services. Geographical restructuring to date has followed a pattern of hospital closures in rural and lower socio-economic (SES) areas and expansions of larger hospitals located in higher SES areas (Folland et al, 2001; Ginter et al, 1998; McLafferty, 2003). Subsequently, rural-to-urban restructuring has resulted in overall greater concentration of healthcare services in large tertiary hospitals thereby decreasing access by increasing the distance and travel time to healthcare services. This geographical restructuring of health services has most notably impacted rural populations. Significant decreases in healthcare services to the already vulnerable, at-risk rural populations have compounded the existing problem of healthcare disparities.
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