Most of our modern medical system is oil-dependent, just like the rest of society. Oil has been so cheap for so long that it has become a pervasive presence in health care delivery. This impact is most obvious when one looks at the transport systems required to maintain a health service. Just as suburbia has been subsidised by the endowment of cheap and plentiful oil, modern medical care is predicated on the cheap movement of things and people from one place to another. This cheap transportation is so crucial that the system must fall apart if no alternatives are developed before oil becomes scarce and even more expensive. This article examines these issues from the perspective of large hospitals - they represent one of the most centralised expressions of health care delivery, and will probably become one of the first major casualities of peak oil.

1. Transport
Modern healthcare facilities are open systems that consume inputs and produce wastes. With few exceptions, almost none of the inputs are created on site, and must be brought to the facility (usually by road). Examples include food, medical supplies, linen, and medical gases like oxygen. Outputs include general rubbish as well as clinical (ie contaminated) waste that reqiures special handling and disposal (either landmass or incineration). The other big transport category is people - staff, patients, visitors and students need to travel to and from the site.

2. Direct Content
Many items used in modern medicine contain petrochemical derivatives. Some of the main categories are gloves (synthetic rubber), clinical disposables (like syringes), medications, sterile packaging (mainly plastic), high-tech equipment like CT and MRI scanners, and computers.

3. Embodied
Many items that don’t directly contain petrochemicals do have oil-based products embodied within them. Producing stainless steel or titanium joint-replacement components may require oil at several steps, including mining, refining, manufacturing, transporting, and packaging.

4. Energy Production
There are two main categories - offsite (natural gas-fired power stations) and on-site (oil or gas for heating and steam generation).

5. Processes
Activities within hospitals like laundering (hot water) and equipment sterilisation (steam, plastic packaging, ethylene oxide) might be oil-dependent.

6. Roads and Buildings
Maintaining and constructing buildings and roads may include multiple oil-dependent processes.

7. Emergency Services
Most emergency services in Western society are vehicle-based and run on petrol or diesel. The majority are cars and trucks but also (especially) helicopters.

8. Organisational and Political Systems
Healthcare services exist within a complex system of modern society. They currently reside within a hierarchial structure of local, state and federal government, health insurance companies, vocational colleges, registration boards, and many other political and pseudopolitical entities. All are currently dependent on oil to a greater or lesser extent (especially for transporting people and things).

Outcomes
So what changes could peak oil bring to our health-care system? Like the impacts on the rest of society, it will partly depend on the rapidity of oil scarcity and the amount of preparation. In the short term there will probably be decreased and unequal access to services, rationing, and a reduction in quality of life (we might be sicker, more mentally ill, and not live as long). In the longer term, a successful transition will need to involve more personal responsibility for one’s own health, as well as a more informal and dispersed health care system centred on the small-community / village level.