When we see things like: "it is not uncommon for her patients to drive two hours for an appointment, as maternal wards have closed at rural hospitals. "
it's probably due to demographic changes more than defunding healthcare as such. If you have communities where there are no jobs, people move out, population diminishes, that also means that some services are shut down.
This happens also in my country (which is a North European welfare state with good pre- and postnatal care and very low child mortality): some people have to go quite far away for the check-ups.
That's more economics than demographics. But yes, Hospitals and medical services in rural communities are disappearing at a phenomenal rate. Demographics do play somewhat of a role, but nothing compared to the change in our healthcare system (and how we pay for it) in the past 50ish years.
It has in part to do with increased cost of healthcare, difficulty of having one family doctor offices, necessity of specialized services (all leading to an agglomeration effect, why you now see "healthcare cities" in more rural areas, where one city among a dozen has the only hospital and lots of other medical services available.) I'd also say that many hospitals are now parts of large chains that are "not-for-profit" in name only, while acting exactly like for profit entities.
While rural areas are typically shrinking, there is still a very large amount of people who live in rural areas in the US. It's the loss of their economic impact (and the above factors) that have made their medical services disappear.
But it's a complex issue and no one seems to have found a solution here in the US yet. But it's going to keep getting worse in the foreseeable future.
it's probably due to demographic changes more than defunding healthcare as such. If you have communities where there are no jobs, people move out, population diminishes, that also means that some services are shut down.
This happens also in my country (which is a North European welfare state with good pre- and postnatal care and very low child mortality): some people have to go quite far away for the check-ups.