The original intent of this thesis was to examine the health care needs of older people living in small rural communities and how those needs might best be met. Interest in this topic arose initially from my involvement in the restructuring of rural health services when, in 1993, individual hospital management, with separate Boards of Directors, was replaced with the aggregation of groups of hospitals into district health services with a corporate board. In 1996, these district health services were restructured and aggregated into eight area health services covering the rural portion of New South Wales. This was undertaken to achieve consistency with the area health service structure found in the metropolitan areas of New South Wales for some considerable time. Without debating the merits of these changes and restructures, they did, in my view, represent an alienation of local communities from direct involvement in the control and management of the health services, a focus on corporate management and an emphasis on efficiency ahead of effectiveness.