The role of risk theory in rural maternity services planning.

The recent closure of rural health services in many developed countries has been a natural experiment as health planners strategically adopt regionalized systems of care to combat staggering healthcare system costs. Regionalization is predicated on offering health services in selected discrete locations (‘referral centers’) as opposed to in every local community of reasonable size. Where complex, specialistbased care is required, this approach is fiscally sensible, professionally sustainable and leads to good patient outcomes. When the dislocated service falls under the umbrella of ‘primary care’ (those services that in usual circumstances do not require specialist support but instead benefit from a generalist, wholistic model of care), the efficacy of care in referral communities is not as clear. Notions of ‘risk’, both of local care and care in a referral center, is at the heart of this discussion. This phenomenon is perhaps best illustrated with the case of rural maternity care. The purpose of this Editorial is to extrapolate contemporary theories of risk and apply them to a current and pressing health service delivery issue as a way of illuminating their usefulness in framing the discussion.