Outcomes of public health reform – service availability in rural areas

Purpose – The purpose of this paper is to focus on the availability and demanded locations of health care services in a rural context. The authors analyse subjective experiences because mobility and other individual factors influence the availability of public services. Design/methodology/approach – Results from a mail survey in southeastern Finland are presented. Data collection was conducted using a random sample of 3,000 people from age 60 to 90 years. A total of 1,121 valid responses were received. Findings – The acceptable distance to service sites depends on learned behaviour where differences exist between suburban and rural residents. The authors found that service networks can be sparser in rural areas if the service sites are located in the daily activity space of the residents and travel burdens caused by distance and time are adequately solved. However, continuous downscaling of the provision may lead to the loss of health benefits which is harmful for individuals and expensive for society. Research limitations/implications – Further research should assess a broader variety of residential areas from the perspective of service availability. The results presented do not enable a direct comparison of the service availability between cities and sparsely populated rural areas. Originality/value – The paper contributes to the debate on access barriers to public service in rural regions. The question of availability of public services is topical because increasing overall demand requires urgent productivity improvements in public services. Currently this is solved by centralisation to search economies of scale.