ABSTRACT
This chapter discusses the problems posed by impaired access on the health and healthcare of rural populations and describes the responses that have been developed to cope with them. The trend towards increasing centralisation of trauma services has been criticised for paying too much attention to the potential advantages of centralisation and not enough to the extent to which delays in reaching hospital care contribute to preventable deaths. The popularity of community hospitals with health service planners has waxed and waned over many years, representing, in part, the tension between centralisation and access to local services. Advances in technology now mean that it is relatively straightforward to transmit images from remote healthcare facilities for assessment in centralised specialised units. While mobile provision may improve access and therefore equity for rural populations, it is staff-intensive and often seen as less efficient than static provision.
