This paper examines the effect of road construction on the catchment area of a church hospital. It is hypothesized that the new road will reduce the spatial and travel cost relationships for the hospital's patients. Analysis of the data suggests that the space-reducing effect of the new road is more important than its effect on travel costs. Reductions in the cost of travel have not significantly changed the spatial pattern of in-patient utilization. In contrast, out-patients show the hospital is attracting patients from further afield, though this involves a similar expenditure on fares to that prior to road construction. Institutional barriers, particularly the economic barrier of fee-paying treatment, are found to be the main explanation for this finding. The high cost of medical treatment also goes some way towards explaining the low level of child treatment apparent in the patient records.