Rural Health Services
Because of its vast extent, its harsh winter climate and in some provinces, geographical features which make travel very difficult, Canada has major problems in providing universal and equally accessible health care to all citizens.
Although the emphasis in the early days of the shift to collectivist health care organization was put upon universal access to medical and hospital services, this has not been easy to achieve. The provincial inquiries into health service provision conducted in the second half of the 1980s (which will be discussed in Chapter 29) reported that rural dwellers were not satisfied with what was being provided for them. The population is unevenly and widely spread. There are far fewer people living in rural areas than in metropolitan centres and so it is difficult to meet the promise of providing readily available comprehensive care to all Canadian citizens.
As discussed in Chapter 9 the clinical medical care system is organized into regional hierarchies. Tertiary care is given only in metropolitan centres where there are medical schools (or regionally by some arrangement with them), secondary care is available in larger towns and primary care is at the base of the pyramid. But the primary and secondary care physicians are not evenly distributed. There is a clustering of most of them as near to the university teaching centres as they can manage to locate their practices. 1
There was a growing concern about the distribution of care between metropolitan and rural areas in the late 1980s. Ontario (Rourke 1989), Quebec (Hirsch and Wooton 1990), and the Alberta Medical Association (1989)____________________