The geography of health care systems

We begin by defining what is a health care system? As medical science and medical geography have evolved since the 1950s, so has thinking about what constitutes a health care system from a relatively simple system focusing on single physician practices, hospitals and asylums to complex systems of single and multiple group practices, community health and mental health centres, hospitals, long-term care (LTC) facilities, etc. As health care systems have become more complex so have the issues of access to health care services. The impacts of demographic transitions resulting from declining fertility rates, changes in internal migration patterns, legal and illegal immigration, forced migration resulting from wars and natural disasters challenge the notion of who has access to health care. Similarly, changing social and economic values also raise questions about who has access to health care. In every country, the questions of who should have access to the health care system and how do we make health care accessible is leading to the restructuring of health care systems. The sites of the health care system are increasingly contested places. Another outcome of restructuring or in some cases the breakdown or even collapse of national health care systems is that people are seeking health care from alternative or traditional health providers or in their homes creating new spaces in the health care system. We conclude our discussion by pointing to the growing complexity of the geography of health of care systems and the research challenges this creates.