Official websites use. Share sensitive information only on official, secure websites. This is an open-access article distributed under the terms of the Creative Commons Attribution 4. Many countries report difficulties in preserving access to care in rural areas.
This paper examines how hard-to-serve regions sustain care provision by transforming service delivery into population health systems. The paper builds on theory on care delivery in hard-to-serve regions. It presents a qualitative case study from the Lower Engadin, a rural high mountain valley in the Swiss Alps. Data sources include semi-structured interviews, participant observations, and documents. Data are analysed using recent conceptual research on population health systems.
The case study illustrates how politicians and providers in the Lower Engadin resolved a care crisis and preserved access to care by forming a population health system. The system is organised around the Healthcare Centre Lower Engadin. Citizen-centred interventions target an aging population and include health promotion and prevention programs as well as case management based on an ambulatory-before-inpatient care strategy.
Hard-to-serve regions like the Lower Engadin preserve access to care by reorganising service delivery towards population health systems. The paper contributes to research on population health systems and care provision in rural areas. Healthcare systems around the world are challenged not only by demographic aging and a growing number of patients with complex needs, but also by regional disparities in care provision [ 1 , 2 , 3 , 4 , 5 ].
Especially rural regions experience growing difficulties in sustaining access to affordable, high quality care [ 2 ]. These strategies aim to address the problem by increasing the number of professionals. Other scholars view supply shortages not only as a quantitative problem, but also as a question of how care is delivered, arguing for qualitative organisational reforms.
