[raverbashing]

There's no secret to solving this problem, and it works basically the same way everywhere

Yes, in France you might be 1h/2h by car from a hospital depending on what you need

You have a tiered system: 1st level is "everyday stuff", 2nd level is regional centers (so you get routine surgeries and more complex stuff), and at the 3rd level you got your excellence centers for specialized stuff (think transplants, major surgeries, etc)

In the US case yes, you might want to have a 3rd level center per state (might not be exaustive)

[apathy]

Per state? Try per region. My department serves a tertiary referral facility and there's another one across town. Of course, "town" is 18 million people, but you get the idea.

I guess I could see having one tertiary center to serve say VT and NH but if memory serves even they have one apiece.