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.
Behavioural health is delivered through physical sites on the Certified Community Behavioral Health Clinic model: 24/7 crisis response, integrated substance-use treatment, care coordination, and an obligation to serve regardless of ability to pay. This is the largest single site category in the build — larger than primary care.
Dental, vision and hearing sit in the floor with different ramps, because their workforce constraints differ sharply.
Telehealth non-inferiority is best established in mental health, which is exactly why over-reliance is tempting. Crisis response, involuntary hold, severe mental illness, medication-assisted treatment for opioid use disorder, and anything involving children require physical presence. A telehealth-primary system serves mild-to-moderate anxiety and depression and abandons serious mental illness — the population private markets already abandoned.
The frequently cited 177,514-patient VA video-to-home cohort is mental-health evidence. It supports video mental healthcare; it does not validate telehealth as a general rural-access backbone, and it should not be cited that way.
Tele extends into low-density catchments as reach rather than as substitute. Mobile crisis teams replace police response.
Dental covers examination and diagnostic imaging, cleaning, fluoride and sealants, fillings, treatment of acute pain and infection, urgent endodontic care where tooth preservation is reasonable, extraction, and basic dentures. Coverage activates regionally against published workforce and waiting-time standards, with the Authority carrying a legal build obligation and a duty to report the unmet queue — so the entitlement is never a paper promise where no capacity exists. Roughly a third of dentists do not accept public coverage, and universal dental needs a workforce build comparable to the primary-care build. Crowns, implants, advanced periodontal reconstruction, cosmetic work and most orthodontics remain supplemental or later-ratchet.
Vision enters at launch or very early: routine examination, refraction, standard frames and lenses, medically necessary replacement. It is the highest benefit-per-dollar item available and the workforce already exists.
Hearing covers diagnostic evaluation, a standard effective device, fitting and basic follow-up, and reasonable replacement intervals — ramping more slowly than optical. Premium devices remain supplemental.
Promising a dental benefit the workforce cannot staff is the same overpromise the program criticises elsewhere.
Which is why activation is regional and gated on published workforce and waiting-time standards rather than declared nationally on a date. The Authority's build obligation and published unmet queue are what convert a gated benefit into an enforceable one.
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.
- Dental capacity modelling is the least developed part of the build.
- Emergency-department boarding is named as a strategy and not yet designed.