Coverage is universal from day one and never partial. What improves over time is the distribution of travel times — a mean, a spread and a tail — moved down by density and staffing. A distribution has no completion state, so access is never reported as a percentage complete. It is measured by condition and time to definitive care, and its honest milestone is the crossover year when as many sites open as close: net-negative today, and plausibly a twenty-year horizon. This clock runs separately from the transition, and for longer.
Every eligible resident is covered for obstetric care, trauma care and everything else in the floor on day one and at every point after. Coverage is never partial.
What varies is travel time — a distribution with a mean, a spread and a tail. Density and staffing move that distribution down. A distribution has no completion state, so access is never reported as a percentage complete.
Build figures like "85% of planned obstetric units" are construction inputs. Published as outcomes they imply people are uncovered, which is false and is the worst thing this program could imply.
The distinction also separates two clocks that get run together. The transition is binary and dated: who is on which plan, who pays how, whose income falls. Access density is a trajectory measured in decades. Putting an access percentage on the transition clock produces a promise the program cannot keep and did not make.
Access is measured by condition and by time to definitive care, not by time to an emergency room — which measures the wrong destination.
Share of births more than 30 minutes from surgical delivery capability. Time to the appropriate level of neonatal care including transport. Population within 60 minutes of a Level I or II trauma centre. First medical contact to device within 120 minutes for STEMI. Time to thrombolysis and to a thrombectomy-capable centre for stroke. Time to first antibiotic for sepsis. Plus ambulance deserts on the published 25-minute methodology.
The honest milestone is the crossover: the year as many sites open as close. Rural obstetrics is net-closing today. Reaching crossover and then net-positive plausibly takes twenty years, and that horizon belongs to this clock rather than the transition's.
Amenable mortality — deaths avoidable given timely, effective care — is the central outcome. Everything else in the dashboard is process. Savings created by queues or absent clinicians are not counted as success.
- Geography and the access bundle
- The bundle is the instrument that moves the distribution.
- Who moves, and when
- Enrollment date and travel time are different facts about the same person.
Refusing a completion percentage makes the program unaccountable — there is no date at which anyone can say it failed.
The opposite. A percentage of units built is unfalsifiable as an access claim; a travel-time distribution published quarterly by catchment is not. The crossover year is a hard, checkable test, and it is currently being failed.
Honesty about gaps. Distributed Healthcare has more unresolved specification than other Engines because operational complexity is higher; the items below are flagged for v10.2 specification or for outside expert review.
- Baseline distributions by catchment need publishing before the first year, or there is nothing to measure improvement against.