Revisiting rural healthcare access through Held's ethics of care

Access to healthcare and health seeking behaviours of rural people often hinge on the existing relationships between healthcare providers and (prospective) healthcare users. However, rich micro-level health professional-healthcare user relationships and the unique relational context of rural settings are largely missing from dominant rural healthcare access conceptual frameworks. We argue rural healthcare access conceptualisations require revisiting from a relational perspective to ensure future healthcare access policy accounts for the relational nature of healthcare in rural contexts. Ethics of care is a moral theory informed by feminism which rejects liberal individualist notions and emphasises interdependence. We used Held’s ethics of care characteristics to examine Russell and colleagues’ healthcare access framework and dimensions for rural and remote populations. This process revealed Held’s ethics of care characteristics are only somewhat evident across Russell et al.’s dimensions: most evident in the acceptability and accommodation dimensions, and most absent in the availability and affordability dimensions. Future rural healthcare access frameworks need to pay further attention to the relational aspects of rural healthcare, particularly around the availability and affordability of healthcare, to bolster future efforts to improve healthcare access for rural people.