Reconsidering Governance Models to Strengthen Rural Healthcare
F McDonald1,2, C Malatzky3, D Sedgwick Fincher4
1Faculty of Law, Victoria University of Wellington, P.O. Box 600, Wellington, 6140, New Zealand. fiona.mcdonald@vuw.ac.nz.
Journal of Bioethical Inquiry
|October 23, 2025
Summary
This study advocates for shifting healthcare governance from centralized control to democratic participation. Empowering local communities is crucial for improving healthcare access in regional, rural, and remote areas.
Area of Science:
- Health Policy and Governance
- Public Health
- Health Services Research
Background:
- Current healthcare systems often exhibit metrocentric and technocratic biases.
- Neoliberal approaches marginalize community voices, treating them as secondary inputs.
- Inequitable healthcare access persists in regional, rural, and remote settings.
Purpose of the Study:
- To advocate for a paradigm shift in healthcare decision-making power.
- To promote democratic and participatory governance models in health systems.
- To enhance healthcare access and delivery in underserved geographical areas.
Main Methods:
- Critique of existing neoliberal healthcare governance frameworks.
- Analysis from health justice and spatial justice perspectives.
- Argument for integrating public participation into health system governance.
Main Results:
- Re-balancing decision-making power is essential for equitable healthcare.
- Participatory governance can improve healthcare access in non-metropolitan areas.
- Community self-determination is linked to effective health service delivery.
Conclusions:
- Democratic and participatory models are vital for addressing healthcare disparities.
- Shifting governance empowers local communities as active agents in healthcare.
- Health and spatial justice necessitate inclusive decision-making in health systems.
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