Healthcare is huge. It's amazing how terrible access to good care is in many rural areas. It's something people often overlook but it's just so important.
The problem is a mix of people leaving rural areas which increases per patient overhead at facilities, plus mergers and private equity takeovers.
Hospital chains and healthcare systems have been consolidating like crazy for decades and it's still going strong - 80 or so hospitals merge every year. PE has also been snapping up private practices like crazy, too.
Though the consolidation is something of a mixed bag. My community hospital network had some pretty good docs but lab work, appointments, and so forth was pretty much faxes and phone calls which sometimes worked. Now they're on Mass General Brigham's electronic records system and it's a lot better.
It's not quite that bad. For example, the Boston area is arguably as good or better than those two cities. And some higher-income relatively small town/rural areas are pretty decent. But it definitely becomes a bigger consideration as you get older--although you can of course get unlucky at any time.
It’s a problem in the medium sized cities too? Because many of the smaller rural facilities are being closed down (often in the wake of for-profit buyouts), and then all those displaced patients overrun the remaining facilities in surrounding towns.
Here in Australia people retire ‘down the coast’. For us that’s the stunning south of NSW. Look up Eden (yes, really, Eden).
And then … they come back to the city. Because the older you are the more medical care you need, and there just aren’t enough doctors down there, or in any other regional area.
