A review of the literature on access and utilization of medical care with special emphasis on rural primary care

Over the past 35 years medical care resources in the United States have become increasingly concentrated in medical centers and university hospitals of large urban areas. This trend has left inhabitants of rural areas increasingly relatively deprived of access to health care resources. More importantly, this relative deprivation of access to medical resources has been a key factor explaining ruralite's deprivation in the utilization of those resources.

Although policy makers have been aware of the evolving structural pattern of the industry for some time, to date they appear unwilling and/or unable to fundamentally alter its continued growth and development. This review describes various forces influencing this developmental pattern at both the individual and the system (macro) level. It further discusses how government health policy, the characteristics of the health delivery system and the characteristics of the U.S. people transactionally relate to affect access to and utilization of health care resources.