[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.