[skissane]

Isn't this true just about everywhere? Someone who lives in a major urban area is going to have more prompt access to advanced emergency healthcare than someone who lives in a remote rural area, simply due to factors such as travel time, and the clinical need to physically concentrate specialist medical resources (specialist clinical teams need a certain minimum case volume to properly maintain their skills, and if you try to spread them too thinly, you can actually worsen patient outcomes)–but that inevitably means that some people in remote rural areas will die before they get the treatment they need, whereas they may well have survived if they'd lived in a major urban area instead. Inefficiencies and inequities in healthcare systems can no doubt worsen this phenomena, but even if you could have the most efficient and equitable healthcare system possible, it would still inevitably happen, even if to a somewhat reduced degree.

The only countries which can totally avoid this problem, are those that are so small that the whole country is a single major urban area, and "remote rural areas" either don't exist at all, or are such a minuscule percentage of the population as to be a statistical rounding error – so basically city-states such as Singapore, Monaco or Vatican City

[lolinder]

This addresses the title but not the content. The NHS is failing to meet its own goals in a pretty bad way, pretty much everywhere. Whether this is true in every country I don't know, but it's certainly not an inevitability.

> The analysis assessed how quickly patients can access health care in each of England’s 533 constituencies — the British term for electoral districts — and found that nearly every single area is failing to meet even half of eight key indicators tracked by the government, from hospital bed availability to ambulance waiting times. A fifth are meeting none.

[skissane]

> Whether this is true in every country I don't know, but it's certainly not an inevitability.

Australia has pretty terrible health care in many of its rural areas, and Australia's governments (both state/territory and federal) are clearly guilty of major policy failures in rural/remote healthcare provision.

But even supposing they did a much better job, even supposing they did the best job humanly possible – you are still going to get higher mortality and morbidity somewhere like Ivanhoe [0] – a town of less than 300 people, 800 km by road west of Sydney – than in the Sydney metro area. It is just the inevitable tyranny of distance. Far Western NSW simply doesn't have the necessary population to sustain the most advanced health care facilities (tertiary/quaternary), and the inescapable physical delays in getting to them (even using air evacuation) is going to cause deaths and clinically inferior outcomes.

Now of course, England is geographically a much smaller country than Australia – England has over twice Australia's population in less than 2% of the area. However, even in England, I would be surprised if the impact of geography on mortality and morbidity completely disappeared – inevitably, even if the NHS were the best health system humanly possible (and it obviously isn't), someone who lives in central London is going to have faster access to the most advanced healthcare than someone who lives in Penzance, [1] – and there are going to be times when that difference makes a real impact to mortality and morbidity.

[0] https://en.wikipedia.org/wiki/Ivanhoe,_New_South_Wales

[1] https://en.wikipedia.org/wiki/Penzance

[lolinder]

For reference on just how much smaller England is—your example of Sydney to Ivanhoe would get you nearly all the way from North to South—it's about the distance from London to Aberdeen.

And again, most of the metrics here (bed availability, for example) should not be geographically bound at all.

[skissane]

> And again, most of the metrics here (bed availability, for example) should not be geographically bound at all.

Is that true though? A less densely populated area would have a lower baseline number of hospital beds, which I'd expect would make it more sensitive to unexpected volatility in demand. Major hospitals often have empty wards which are kept available as contingencies for unexpected events such as terrorist attacks or natural disasters – I've seen one in person before, all these beds and medical equipment with the lights turned off gives me goosebumps for some reason – less major hospitals are less likely to have such facilities – but obviously they give hospital management greater leeway (at least in theory) to manage unexpected bursts in demand. And of course, less densely populated areas are likely to have fewer major hospitals and a greater number of minor ones. Similarly, larger hospitals have larger staffs, so greater likelihood they can ask extra staff to come in to meet unexpected demand bursts.

So, in the abstract, I would not be surprised if less densely populated areas of England had worse bed availability than more densely populated areas. And indeed, the least dense area of England, the South West, scored the worst in hospital bed availability in their analysis–as I would have expected.

I think that is a flaw in the methodology of this article, they display no evidence of having considered factors like that, or having attempted to control for them.

[jpollock]

As the population goes up, the variability is likely to go down. Single people are less of a blip in the numbers.

This means you can run with fewer free beds than in a low population area.

For example, if you have 3.8 beds/1000 people, that's 4 beds in a town of 1000 people.

A single additional person is 25% of the beds in the small town. A car crash? You won't be able to fit them in.

In a city of 50,000 people, that's 190 beds, and random events fit in the slack much more easily.

Also, since the baseline is larger, it's easier to scale. The minimum addition in the small town is a whole bed, or a 25% increase in costs.

In the city, it's also 1 bed, but that's ~0.5%.

[analog31]

I live in a mid sized urban area, a few blocks from a large hospital. My location was certainly beneficial when I needed emergency treatment. But for anything non-emergency, the waiting lists and "pre approval" battle are appalling.

My spouse, who lives in the same house, but has a different employer, gets much quicker treatment from the same clinics.

[dkh]

How is this? All other things equal, certain companies simply get to jump the line over others?

[skissane]

I’ve personally experienced insurers having different “levels” of plans, and some employers pay for a higher level of cover than others. Once, I switched employers, my new employer perchance used the same health insurer as my old employer-but at a lower level of coverage.

[dkh]

I've seen and experienced this as well, but not to the point where calling the same doctor for an appointment would get me in earlier or later. More typically I have access to different doctors altogether, or need approval for certain doctors, or have different out-of-pocket costs.

[analog31]

Different insurance providers, each of which has its own rules about approving care.

[zx8080]

Do they differentiate men/women? Another, is the insurance company same for both?

[civilitty]

In the UK it’s much worse than normal for rural areas due to chronic underfunding of social services and healthcare.

There’s too many factors to go into but the most pressing issue is that there aren’t enough care home beds available to discharge elderly patients so there’s not enough beds available in hospitals. Ambulances often have to wait long times before they can unload a patient at the hospital which ties them up - at one point ambulances had to wait over an hour on one out of ten trips nationally (thats just the stat the NHS keeps, they often wait for much longer than an hour).

Combined with population growth significantly outpacing growth in NHS budget and staffing, it’s created a perfect storm of shite.

[themitigating]

You mentioned the population growth but what about aging population? Because of that wouldn't funding need to be exponentially increased each year. At the same time a smaller working population and who are against tax increases would make that difficult.

[nvm0n1]

Integrated healthcare systems in other countries like Kaiser can balance patient flows between hospitals and care homes. This is something that in theory the UK should be good at given it's also an integrated system, but the dysfunction caused by trying to have the government centrally plan everything means it doesn't work in practice. The issue isn't under-funding, the UK social/healthcare system has plenty of money relative to peers.

Beyond general disorganization the UK system shoots itself in the foot regularly. Care homes are bottlenecked by labor cost, so their solution was:

1. Raise the minimum wage, thus increasing care prices and ensuring more people can't afford to pay for it even though there's lots of available labor.

2. Fire huge numbers of carers because they didn't want to get vaccinated, even though the vaccines weren't reducing transmission and their elderly tenants were multiple-vaccinated anyway.

(2) was especially damaging because care homes were one of the few sectors that had vaccine mandates in the UK, so people have now learned that if they go to work at care homes then they will be forced to take experimental medical things even if they don't want to or if it doesn't seem to make sense. That's a big downside to a job that already had few upsides.