Telemedicine is an innovation that is changing the geography of medical care provision. Regionalization of care is one important type of geographical change resulting from the implementation of telemedicine technology. This paper introduces a range of issues bound up with telemedicine and medical care regionalization and offers a geographical conceptualization of those issues through a synthesis of ideas from several literatures. It begins by providing a background for regionalization and telemedicine. The paper continues by examining the formation of ‘virtual’ regions and the problem of their internal integration and integration with ‘material’ regions of care. A penultimate section argues for the use of regional economic geography and territoriality as contexts for understanding the continued growth and development of telemedicine networks. As part of an overall critical challenge to the protelemedicine bias in the medical care literature, the paper ends by suggesting the development of a normative ethics by medical geographers.
Adams, L.N. and Grigsby, K.R.1995: The Georgia state telemedicine program: initiation, design, and plans. Telemedicine Journal1, 227–235.
2.
Bashshur, R.L.1995: On the definition and evaluation of telemedicine. Telemedicine Journal1, 19–30.
3.
Bashshur, R.L.1997: Telemedicine and the health care system. In Bashshur, R.L., Sanders, J.H. and Shannon, G.W., editors, Telemedicine: theory and practice, Springfield, IL: Charles C. Thomas, 5–35.
4.
Bashshur, R.L., Reardon, T.G. and Shannon, G.W.2000: Telemedicine: a new health care delivery system. Annual Review of Public Health21, 613–637.
Beyers, W.B. and Nelson, P.B.2000: Contemporary development forces in the non-metropolitan west: new insights from rapidly growing communities. Journal of Rural Studies16, 459–474.
7.
Bohland, J. and Knox, P.1989: Growth of proprietary hospitals in the USA. In Scarpaci, J., editor, Health services privatization in industrial societies, New Brunswick: Rutgers University Press, 27–64.
8.
Burgiss, S.G., Blaine, L.E., Brooks, C., Foster, C.D. and Smith, G.T.1998: Medicine without boundaries. Forum for Applied Research and Public Policy13, 101–105.
9.
Charles, D.R.1996: Information technology and production systems. In Daniels, P.W. and Lever, W.F., editors, The global economy in transition, Harlow: Longman, 83–102.
10.
Church, J. and Barker, P.1998: Regionalization of health services in Canada: a critical perspective. International Journal of Health Services28, 467–486.
11.
Crampton, J.1999: Virtual geographies: the ethics of the internet. In Proctor, J.D. and Smith, D.M., editors, Geography and ethics: journeys in a moral terrain, London: Routledge, 72–91.
12.
Dicken, P.1998: Global shift: transforming the world economy(third edition). New York: Guilford Press.
13.
Economic Research Service.1995: Understanding rural America. Washington, DC: USA Department of Agriculture, Agriculture Information Bulletin No. 710.
14.
Economist1998: IT and health care: bugs and viruses. 28 February, 66-68.
15.
Eyles, J. and Litva, A.1998: Place, participation, and policy: people in and for health care policy. In Kearns, R. and Gesler, W.M., editors, Putting health into place: landscape, identity, and wellbeing, Syracuse, NY: Syracuse University Press, 248–269.
16.
Field, M.J.,editor, 1996: Telemedicine: a guide to assessing telecommunications in health care. Washington, DC: National Academy Press.
17.
Florida, R.1996: Regional creative destruction: production organization, globalization, and the transformation of the Midwest. Economic Geography72, 315–335.
18.
Gesler, W.M.1991: The cultural geography of health care. Pittsburgh: University of Pittsburgh Press.
19.
Gesler, W.M., Hartwell, S., Ricketts, T.C. and Rosenberg, M.W.1992: Introduction. In Gesler, W.M. and Ricketts, T.C., editors, Health in rural North America: the geography of health care services and delivery, New Brunswick: Rutgers University Press, 1–22.
20.
Ginzburg, E.1977: The many meanings of regionalization in health. In Ginzburg, E., editor, Regionalization and health policy, US Department of Health, Education, and Welfare Publication no. 77–623, Washington, DC: Government Printing Office, 1–6.
21.
Graham, S.1998: The end of geography or the explosion of place? Conceptualizing space, place and information technology. Progress in Human Geography22, 165–185.
22.
Graig, L.A.1999: Health of nations(third edition). Washington DC: Congressional Quarterly Press.
23.
Grigsby, J.1997: Telemedicine in the USA. In Bashshur, R.L., Sanders, J.H. and Shannon, G.W., editors, Telemedicine: theory and practice, Springfield, IL: Charles C. Thomas, 291–325.
24.
Grumbach, K. and Anderson, G.M.1996: Access to care in regionalized health care systems – reply. Journal of the American Medical Association275, 759.
25.
Halfacree, K.H.1993: Locality and social representation: space, discourse and alternative definitions of the rural. Journal of Rural Studies9, 23–37.
26.
Harrison, B.1994: Lean and mean: the changing landscape of corporate power in the age of flexibility. New York: Basic Books.
27.
Hassinger, E.W.1982: Rural health organization: social networks and regionalization. Ames, IA: Iowa State University Press.
28.
Hickman, L.A.1990: John Dewey's pragmatic technology. Bloomington, IN: Indiana University Press.
29.
Hillis, K.1998: On the margins: the invisibility of communications in geography. Progress in Human Geography22, 543–566.
30.
Hugill, P.J.1993: World trade since 1431: geography, technology, and capitalism. Baltimore: Johns Hopkins University Press.
31.
Hurley, J., Birch, S. and Eyles, J.1995: Geographically-decentralized planning and management in health care: some informational issues and their implications for efficiency. Social Science and Medicine41, 3–11.
32.
Information Highway Advisory Council.1997: Preparing Canada for a digital world: final report of the information highway advisory council. Ottawa: Industry Canada.
33.
James, A.1999: Closing rural hospitals in Saskatchewan: on the road to wellness?Social Science and Medicine49, 1021–1034.
34.
James, P., Wysong, J.A., Rosenthal, T., Bliss, M., Osborne J.,and Lin, G.1996: Access to care in regionalized health care systems. Journal of the American Medical Association275, 758–759.
35.
Kearns, R.A. and Joseph, A.E.1997: Restructuring health and rural communities in New Zealand. Progress in Human Geography21, 18–32.
36.
Kitchin, R.M.1998a: Towards geographies of cyberspace. Progress in Human Geography22, 385–406.
37.
Kitchin, R.M.1998b: Cyberspace: the world in the wires. Chichester: John Wiley.
38.
Knox, P. and Agnew, J.1998: The geography of the world economy(third edition). New York: John Wiley.
39.
Larkin, M.1997: Telemedicine finds its place in the real world. Lancet350, 646–647.
40.
Lewis, C.1977: Improved access through regionalization. In Ginzburg, E., editor, Regionalization and health policy, US Department of Health, Education, and Welfare Publication no. 77–623, Washington, DC: Government Printing Office, 71–84.
41.
Löytönen, M. 2000: Telemedicine and the geography of health. Paper presented at the 9th International Symposium in Medical Geography, Montreal, 3 July.
42.
Luke, R.D.1992: Local hospital systems: forerunners of regional systems?Frontiers of Health Services Management9(2), 3–51.
43.
Malecki, E.J.1997: Technology and economic development: the dynamics of local, regional and national competitiveness(second edition). Harlow: Longman.
44.
Marsden, T., Lowe, P. and Whatmore, S.,editors 1990: Rural restructuring: global processes and their responses. London: David Fulton Publishers.
45.
Mayer, J. 2000: Place, telemedicine, and the doctor-patient relationship. Paper presented at the 9th International Symposium in Medical Geography, Montreal, 3 July.
46.
Mitchell, J.G.1999: The uneven diffusion of telemedicine services in Australia. Journal of Telemedicine and Telecare5(S1), 45–47.
47.
Moscovice, I., Wellever, A., Christianson, J., Casey, M., Yawn, B. and Hartley, D.1997: Understanding integrated rural health networks. Milbank Quarterly75, 563–588.
48.
Murdoch, J. and Marsden, T.1996: Reconstituting rurality. London: University College London Press.
49.
Pappas, G.F.1998: Dewey's ethics: morality as experience. In Hickman, L.A., editor, Reading Dewey: interpretations for a postmodern generation, Bloomington, IN: Indiana University Press, 100–123.
50.
Proctor, J.D.1998: Ethics in geography: giving moral form to the geographical imagination. Area30, 8–18.
51.
Proctor, J.D. and Smith, D.M.1999: Geography and ethics: journeys in a moral terrain. London: Routledge.
52.
Reamy, J.1995: Health service regionalization in New Brunswick, Canada: a old move. International Journal of Health Services25, 271–282.
53.
Reid, J.1996: A telemedicine primer: understanding the issues. Billings, MT: Innovative Medical Communications.
54.
Ricketts, T.C.1999: Introduction. In Ricketts, T.C., editor, Rural health in the United States, New York: Oxford University Press.
55.
Ricketts, T.C.2000: The changing nature of rural health care. Annual Review of Public Health21, 639–657.
56.
Ricketts, T.C., Johnson-Webb, K.D. and Randolph, R.K.1999: Populations and places in rural America. In Ricketts, T.C., editor, Rural health in the United States, New York: Oxford University Press.
57.
Sack, R.D.1986: Human territoriality: its theory and history. Cambridge: Cambridge University Press.
58.
Sanders, J.H. and Bashshur, R.L.1995: Challenges to the implementation of telemedicine. Telemedicine Journal1, 115–123.
59.
Satava, R.M.1997: Telemedicine of the future: a pragmatic speculation. In Bashshur, R.L., Sanders, J.H. and Shannon, G.W., editors, Telemedicine: theory and practice, Springfield, IL: Charles C. Thomas, 393–405.
60.
Schneider, D. and Greenberg, M.R.1992: Death rates in rural America 1939-1981: convergence and poverty. In Gesler, W.M. and Ricketts, T.C., editors, Health in rural North America: the geography of health care services and delivery, New Brunswick: Rutgers University Press, 55–68.
61.
Schur, C.L. and Franco, S.J.1999: Access to health care. In Ricketts, T.C., editor, Rural health in the United States, New York: Oxford University Press, 25–37.
62.
Shannon, G.W.1997: Telemedicine: restructuring rural medical care in space and time. In Bashshur, R.L., Sanders, J.H. and Shannon, G.W., editors, Telemedicine: theory and practice, Springfield, IL: Charles C. Thomas, 37–51.
63.
Shannon, G.W. 2000: Telemedicine: does distance matter?Paper presented at the 9th International Symposium in Medical Geography, Montreal, 3 July.
64.
Shannon, G.W. and Dever, G.E.A.1974: Health care delivery: spatial perspectives. New York: McGraw-Hill.
65.
Sheps, C.G. and Madison, D.L.1977: The medical perspective. In Ginzburg, E., editor, Regionalization and health policy, US Department of Health, Education, and Welfare Publication no. 77–623, Washington, DC: Government Printing Office, 15–22.
66.
Shortell, S.M., Gillies, R.R. and Devers, K.J.1995: Reinventing the American hospital. Milbank Quarterly73, 131–160.
67.
Smith, D.M.2000: Moral geographies: ethics in a world of difference. Edinburgh: Edinburgh University Press.
68.
Storper, M.1997: The regional world: territorial development in a global economy. New York: Guilford Press.
69.
Storper, M. and Walker, R.1989: The capitalist imperative: territory, technology, and industrial growth. Oxford: Blackwell.
70.
Strömgren, M.2000: Health care provision in marginal areas by means of telemedicine. GERUM kulturgeografisk arbetsrapport 2000-04-17. Umeå: Kulturgeografiska institutionen, Umeå universitet.
71.
Swanson, B.1999: Information technology and under-served communities. Journal of Telemedicine and Telecare5(S2), 3–10.
72.
Taylor, P.1998: A survey of research in telemedicine: 2 telemedicine services. Journal of Telemedicine and Telecare4, 63–71.
73.
Telehealth Magazine2000: Take a tour of Fletcher Allen Health Care, Burlington, Vermont (http://www.telemedmag.com/tours/fahc.html), 12 March.
74.
Watanabe, M., Jennett, P. and Watson, M.1999: The effect of information technology on the physician workforce and health care in isolated communities: the Canadian picture. Journal of Telemedicine and Telecare5(S2), 11–19.
75.
Weissert, W.G. and Silberman, S.1996: Health care on the information highway: the politics of telemedicine. Telemedicine Journal2, 1–15.
76.
Wells, R.S. and Lemak, C.H.1996: Beyond adoption to sustained use: telemedicine for rural communities. Telemedicine Journal2, 285–293.
77.
Wennberg, J. and Gittlesohn, A.1971: Small area variations in health care delivery. Science182, 1102–1107.
78.
Wootton, R.1999: Telemedicine and isolated communities: a UK perspective. Journal of Telemedicine and Telecare5(S2), 27–34.
