[jackcosgrove]

I have heard conflicting accounts of inefficiencies in the US healthcare system.

One account is that the US has too many medical facilities in urban areas. In other words, there might be five hospitals each with its own radiology equipment. That equipment is idle some of the time, so you could close some of the imaging departments and leave just one or two for the metro area. That would obviously inconvenience some people, but the gist of the criticism is that the US duplicates medical capacity for the sake of convenience.

The other criticism is that there are too few clinics and such. That's why there was a big push to open health clinics in pharmacies and urgent care locations recently.

Now I know these aren't mutually exclusive; you can have too few clinics and too many hospitals. But I would like to know if anyone is more informed than I am what validity there is to each criticism.

I'm curious what the truth is regarding the number and character of brick-and-mortar healthcare facilities in the US: too many? too few? Because it looks like this company was opening physical clinics.

[inferiorhuman]

  I'm curious what the truth is regarding the number and character
  of brick-and-mortar healthcare facilities in the US: too many?
  too few? Because it looks like this company was opening physical
  clinics.

Services are unevenly distributed and I wouldn't say there's too many providers in urban areas. Rural areas are underserved though (off the top of my head I can think of a movie and a TV series whose premise is rooted in lack of rural care).

Even within urban areas care is uneven. Hospitals are concentrated in the more wealthy parts of San Francisco and the poorer (e.g. southeastern) parts see sparse coverage. One of the big points of contention when Sutter Health bought out St Luke's hospital in SF was that Sutter wanted to transition from primary care to more profitable specialties. This would've left the neighborhood bereft of primary care.

In more rural areas you'll find that funding is a political football. As that funding wanes so does the level of care. On top of that the post-Roe v Wade environment encourages some folks to migrate towards urban areas in more "permissive" states.

In terms of too much urban coverage. When I needed an ultrasound through UCSF I had to book it out months in advance. It's not clear to me that there is a ton of duplication there — more the point if I'd looked elsewhere I would've had to figure out what was/wasn't in network with my insurance provider. Last I looked Kaiser has a grand total of eight urgent care clinics in the Bay Area. There are nine counties in the Bay Area. That's efficient from a business standpoint but leaves plenty of customers out in the cold as Kaiser covers out-of-network services in very limited circumstances. Likewise, try to find a GP that accepts insurance and is taking new patience. When I checked eons ago UCSF had a nearly year long wait.

[jackcosgrove]

Just to be clear the "too much coverage" argument is about physical facilities and equipment, not personnel. I think everyone is in agreement that there is a shortage of medical staff.

As far as convenience vs efficiency, the argument was that to achieve the efficiencies found in other countries, which often have longer wait times for services than the US, you do have to sacrifice convenience. The US, by treating healthcare like a consumer good rather than a rationed utility, has built out excess capacity for the sake of convenience. This is, according to the argument, part of the reason we spend more on healthcare than peers. (Healthcare must always be rationed; the US does so on price rather than wait times.)

[inferiorhuman]

It's not clear to me that wait times for e.g. imaging are due to insufficient staff. UC had two locations (for a city of 800,000) where I could've gotten an ultrasound. Getting waitlisted trying to find a GP isn't a staffing issue either. My solution was to patronize a medical practice that didn't accept insurance. I was able to make a same day appointment as a new patient. The lack of urgent care within the Kaiser network out here isn't a staffing issue. Kaiser simply hasn't built out clinics.

The lack of rural providers is largely a staffing issue, but once the staff go whole departments (e.g. obstetrics) get shuttered and it then becomes a larger problem than merely finding physicians.

Having been through the meat grinder a few times I don't think there's as much "convenience" as proponents of for-profit health care would like everyone to believe. Attributing the uneven distribution of care to convenience misses the mark. Profit incentivizes specialties that can charge higher prices and disincentives primary care. That's not convenience, it's profit. Again. St. Luke's.

[tzs]

> On top of that the post-Roe v Wade environment encourages some folks to migrate towards urban areas in more "permissive" states.

Crucially, among those who leave are not just patients. There are also doctors leaving.

[Spooky23]

Too much generally refers specifically to inpatient beds.

[ketzu]

> One account is that the US has too many medical facilities in urban areas. In other words, there might be five hospitals each with its own radiology equipment. That equipment is idle some of the time, so you could close some of the imaging departments and leave just one or two for the metro area. That would obviously inconvenience some people, but the gist of the criticism is that the US duplicates medical capacity for the sake of convenience.

> The other criticism is that there are too few clinics and such. That's why there was a big push to open health clinics in pharmacies and urgent care locations recently.

Funny enough, germany has the exact same two problems.

* Too many small urban hospitals do too many things, but have no speciality, leading to high cost, underutilization and higher risk procedures.

* Too few specialist doctors for checkups leading to long waiting times.

[dv_dt]

If the radiology equipment was fully filled that would basically guarantee longer ER wait times

[NBJack]

> That would obviously inconvenience some people, but the gist of the criticism is that the US duplicates medical capacity for the sake of convenience.

Or outright kill them due to a delay in a critical finding. This is more than a convenience factor, and moving patients between facilities is non-trivial.

[maxerickson]

The prices charged for imaging have basically no relation to the equipment cost.

It's likely the other way around from what you are saying, with limits to market entry enabling the existing facilities to charge more than the efficient price for the service.

[Suppafly]

>That would obviously inconvenience some people, but the gist of the criticism is that the US duplicates medical capacity for the sake of convenience.

I work for a hospital chain that has done similar things. A lot of the failing hospitals in little towns across the US is because of this, and the consolidation that's happening is to remove similar inefficiencies. People that live in these little towns with failing hospitals see any move towards correcting these inefficiencies as evidence that our medical system is failing and use it to vote for right wing politicians who make empty promises.

[pixl97]

I mean because commonly you shift the problem back to the user's insurance....

If you have 2 hospitals and one takes your insurance and the other doesn't you still get service. If you consolidate to one and they don't take your insurance you may have to drive hours to get medical service.

A huge failure of the system is how health insurance works.

[drannex]

This is what happens when everything has to be privatized, ie, the general problem with capitalism, that the duplication of resources is far more than the system can support.