But some of the medium-sized programmes, which fear for their survival, provide an efficient service for local patients and their families who cannot afford the emotional and economic cost of travelling to some far-flung centre of excellence.

ECONOMIST: States v. Washington

"By putting these two networks together, we would provide better service, more efficient service to consumers, " he said at the Senate hearing in March.

WSJ: Where Airfares Are Taking Off

Senior officers said the merger was not about saving money but would provide a more efficient service and make the most of expertise across the region.

BBC: Crashed car