Closing rural hospitals: reducing "institutional bias" or denial of access?

The existence of many small rural hospitals in the United States may appear to be an expression of institutional bias in the health care system. Thus the impending demise of a large proportion of these facilities because of their inability to compete with urban centers may seem to be appropriate. However, in the absence of alternatives to institutional care or mechanisms for systematic movement of patients to urban centers, rural hospital closure could genuinely reduce access.