North Yorkshire County Council's health scrutiny committee voiced its misgivings after meeting to consider NHS planning guidance for the next five years.
A key part of the guidance centres on Sustainability and Transformational Plans (STPs).
These place-based plans divide North Yorkshire's clinical commissioning groups into three urbanised regions for the delivery of health care services:
Councillors warned that STPs – which will become the funnel for funding transformation in health services – could concentrate spending in more densely populated urban areas.
Healthcare services in North Yorkshire should not, they said, be unduly influenced by the challenges faced in providing services in the urban areas of Middlesbrough, Leeds, Bradford and Hull.
Committee chairman Jim Clark said: "The challenges in these areas are entirely different to those of providing services to the rural and remote communities of North Yorkshire."
Councillor Clark outlined his concerns inb a letter to Moira Dumma, local team director for NHS England for Yorkshire and the Humber.
Rural areas had a reliance on medium-sized district hospitals, a history of the NHS financial deficits, low local government funding settlements and an under-investment in community health services, he said.
North Yorkshire's challenges, which were due to factors associated with sparsity, risked being exacerbated under these new arrangements.
Funding would be further syphoned into urban areas, said councillor Clark.
While the committee supported the priority given to improving performance in acute services and their cost impact, members needed assurance that the importance of maintaining a whole-system approach.
A fair share of funding through the CCGs was needed to "to address the challenges in this county".
Committee members fear that new place planning arrangements will also threaten democratic accountability, creating another tier which "sits outside local and county-wide accountability arrangements".
By contrast, said councillor Clark, the NHS place planning guidance presented opportunities to develop new integrated models of primary care which would be local to where people live.
These would help reduce referrals into secondary care and acute services.
In this respect, North Yorkshire was already pointing the way through its public health and Stronger Communities teams which work closely with community and voluntary groups to take a greater role in direct service provision through active citizenship.
Greater emphasis on primary care and a less clinical approach would build on this greater emphasis on social and emotional needs "which are important to all of us, particularly for people with long term conditions."
Councillor Clark said: "It is crucial that the health challenges faced by rural communities are not overlooked in these new place-based arrangements."