[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%.