The purpose of this paper is to provide rural communities and providers with a framework for thinking about the issues related to local control of rural health services and to formulate the questions they should consider when negotiating with external providers, suppliers and insurers. To elucidate the issues, we begin by expanding briefly on the arguments made by rural health providers and rural health advocates for maintaining local control of health care services. The next section, presented in the form of a dialogue, explores issues of control and availability of rural health services from opposing points of view. The presentation of the issues in this informal manner is intended to stimulate discussions among interested parties around the country concerning the various meanings and consequences of local control. Next we review four different perspectives on local control. Each of these perspectives is informed by the literature of a specific academic discipline: sociology, political science, economics and business, respectively. In the final section, we consider environmental factors that might affect local control of decision making, and propose a list of questions readers should ask when evaluating local control options in their communities.
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