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The rural context for health care systems has been experiencing substantial stress in recent times. The population, from which providers must obtain patients, is no longer growing as it had during the 1970s, but rather is likely to be either stable or decline where agriculture or energy are the primary economic sectors (Agresta, 1985, Johnson, 1989). Accompanying depopulation, in farming and energy producing communities an economic stagnation or depression has also been occurring. Both the loss of population base and restricted economies serve to limit patient use of clinics and hospitals, reducing their revenues and contributing to a further limitation of services



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