Healthcare and territory: debating an integrated approach

Abstract

Prominent economic, social and political changes, mainly over the past decade, which had broad impacts on healthcare services, justify reimagining healthcare decision-making processes. This set of changes puts into debate the competing values of equity and efficiency in articulation with territorial dynamics, impelling the readjustment of both prevailing theoretical viewpoints and strategic actions usually adopted in this field. This paper seeks to clear out the relationship between healthcare and territory according to two issues: the geographical nature of healthcare accessibility, bearing in mind both the urban/rural dichotomy and the recent trends concerning the reorganization of healthcare systems based on a centralization and cost-efficiency perspective, and the consequences on how healthcare services are spatially organised and relate, not only with other healthcare services, but also with the spatial structure of urban systems. Accordingly, this paper aims to ponder on these conspicuous challenges faced by decision-making processes in healthcare and, thus, discuss possible strategic, integrated and more spatially focused paths.