ABSTRACT
The most effective way of providing care to a community is by ensuring equity of access to the most effective medical interventions for the highest possible proportion of the population. The major asset of a community hospital is being close to the community it serves. Inadequate facilities, lack of experience, expertise and training, and the absence of resident staff all lead to an apparent lack of quality. With the exception of dementia care, the provision of mental health inpatient services is not often a feature of community hospitals. The balance between social and medical factors is nowhere more evident than in the provision of maternity care. A vigorous debate continues as to whether surgery is best performed in major units where procedures are being done frequently or whether the quality of surgery is dependent on the skills of the operator even if the procedure is done infrequently.
