The purpose of this study is to re-examine the concepts of health services utilization presented by White and his colleagues In The Ecology of Medical Care'. We re-test their model in a rural population in the southern United States using longitudinal Instead of cross-sectional data and find that the general principles of the Ecology' model do, Indeed, apply to rural populations like Rougemont/Bahama. Use of this model has implications for modifying and improving the organization of the health care delivery system end for a fundamental change of emphasis in medical education. 10.1093/ije/6.1.55