A rural health forum in Wellington has heard that a lack of funding continues to be the most pressing issue facing the sector.
The forum aims to find practical solutions to the challenges of delivering health care to rural communities, which make up more than a fifth of New Zealand's population.
It features representatives from district health boards and primary health organisations, as well as doctors, nurses and other associated rural health providers.
The forum's chair, Dr Carol Horgan, from Dunstan Hospital in Otago, says the rural health sector is still struggling with falling incomes, and rising costs.
She says rural health providers need to do things differently so they can continue to provide an adequate level of service.
Some are already making changes, she says, such as using video technology to save travel costs, and integrating primary and secondary care.
The chief executive of the Southern District Health Board, Dr Brian Rousseau, says the rural health sector is faced with having to deliver more from less.
He told the forum that this is creating a pressure-cooker situation and as a result public expectations will be disappointed, as will those of staff in the health system who "almost feel they are owed the additional money to be able to care for people".
Dr Brian Rousseau says secondary and tertiary rural health providers will need to become more integrated to prevent duplication of services.