A quick glance will reveal that not every county or city has a non-profit, for-profit, or Veterans Affairs hospital. Residents of Scott and many other Virginia counties have to travel to another community for hospitalization, or to visit a relative in a hospital. Scott County residents can go across the state line where, in Tenneessee, there are excellent facilities in Bristol and Kingsport. If you are seriously ill with cancer in Danville or South Boston (and can afford it), the odds are good that you will go to a North Carolina hospital in nearby Greensboro or "the Dukes" (Duke University) in Raleigh-Durham for extended or high-tech treatment.
For emergency services, it's usually best to go to the nearest emergency room... but don't assume they are spread out equally across the state. Based on a map indicating average distance to the nearest three emergency rooms in 1999, would you rather build your retirement dream home in Montgomery or Cumberland County? Obviously, residents in Southside can't schedule a heart attack to occur only while shopping in Lynchburg, Roanoke, or Richmond. If you like the idea of living out your days in the uncrowded mountains of Highland County or with the low cost of living in Southside, one tradeoff is that the health care services are limited.
Many Virginia counties and cities have some sort of hospital (see 1995 map), but it may not offer the services you need or the expertise you can afford. The map showing the average distance from the county center to the three nearest hospitals in 1999 indicates where there is serious competition in medical care in Virginia...
Depending upon your Zip code, you live in one of the 3,436 hospital service areas (HSA's) defined by the Health Care Finance Administration. This helps the Medicare administrators define reasonal "local" costs for dealing with different health care problems. Only 6% of the HSA's have 4 or more hospitals. When a local hospital may not be able to deal with a particular case, it usually refers to patient to another hospital with more expertise and equipment. There are 306 hospital referring regions (HRR's), according to the Dartmouth Atlas of Health Care.
In far Southwestern Virginia, your local hospital will be the Lee County Community Hospital in Pennington Gap, Norton Community Hospital, or Wellmont Lonesome Pine Hospital in Big Stone Gap. Wellmont also offers other facilities in Tennessee - and could absorb Lee County Community Hospital. That facility went through bankruptcy in 2000, after its administrators stole the reserve funds and drained the operating account through white-collar fraud. Though the criminals were convicted, the hospital is seriously weakened financially. Look for it to join with Wellmont or Mountain States Health Alliance (based in Johnson City, Tennessee).
Get closer to the Roanoke area, and there are more choices for patients. The hospitals of the Carilion Health Systems now extend from Pearisburg east to Farmville in Southside Virginia, and from Roanoke south to Marion. The local doctors who formed Carilion also have sponsored the Carilion Biomedical Institute, and obtained support from the Roanoke City Council to convert the rivefront between the two Roanoke hospitals into a biopark.
HCA - The HealthCare Company is a much larger organization, but it has been troubled by claims of poor service and financial irregularities. The Lewis-Gale and Montgomery Community hospitals are in a very competitive environment...
Old sexually transmitted diseases are still a concern nationally, and especially in Virginia. The December 7, 1998 report card says "Syphilis and gonorrhea have reached all-time lows in the U.S." The national health objective for the year 2000 was to reduce gonorrhea to an average of 100 cases per 100,000 population... but in a June 23, 2000 report, the CDC announced that the rate was increasing in Virginia to 137 cases/100,000 residents, just above the national average. Again, Richmond (at 794 cases/100,000 residents) and Norfolk (with 616 cases/100,000) were centers of disease. They ranked in the "top 15" cities reporting gonorrhea cases in 1997.
There is a national plan now to eradicate syphilis from the United States. It is uncommon in many counties, and most common the black male population in the South. Syphilis cases are cyclic, and concentrating on the most at-risk population at the bottom of the cycle makes it realistic to consider elimination of the disease.
According to Table 1 in the 1998 Sexually Transmitted Disease Surveillance Report, new infections are down over 80% in 1998 from the recent peak in 1990. According to Table 24, there were less than 7,000 primary and secondary cases nationwide in 1998, and just 149 in Virginia (an average of just 2.2 such cases/100,000 residents). Infection rates were highest in Norfolk (14.4/100,000) and Richmond (11.4/100,000).
It's probably no surprise that the geographic pattern in Virginia for all three STD's was similar, but the cultural patterns are not consistent and the public health challenges are not the same. Even complete elimination of syphilis is unlikely to have a major impact on infection rates for clamydia, in part because clamydia is diagnosed far more often in young women than in men. Women may seek treatment, but men (who often fail to notice the symptoms of clamydia) will continue to be a source of new infections. See also:
Organs have to be transplanted quickly, so there's an advantage to using them on a nearby patient... but sometimes a patient in greater need is located in a hospital further away. It's necessary to balance different criteria before determining who will receive a donnated heart, lung, kidney, pancreas, etc.
The public policy issues surrounding organ transplantation are complex, confusing, and changing. There are conflicts between the state responsibilities for regulating medicine, Federal responsibilities for payment of Medicaid/Medicare claims, professional organizations claiming a role in representing doctors and hospitals, and of course the ethical issues regarding who gets priority for a limited, life-essential resource.
The Organ Procurement Organizations (OPOs) who collect the organs are private, not public, organizations. Transplant coordinators match the donated organ with a potential recipient, using computerized registers of patients awaiting transplants. Medical criteria determine the suitability for implanting the organ in different situations (based on things like "panel reactive antibody levels" and "antigen matches"), but a great deal of human judgement is also involved (particularly on the part of a physician who determines when to add a patient to the UNOS Waiting List). It's not a cookbook, just-follow-the-numbers process.
Most patients in the United States are awaiting kidney or liver transplants - see the current list. There is not a national waiting list, however. There are roughly 60 organ procurement organizations (OPO's) in the United States. Over 50 are "independent," supplying organs to two or more transplant centers. According to the UNOS by-laws, OPO's that serve only one transplant center are eligible for only non-voting membership.
Organs can't be "harvested," cross-matched for compatibility, and transported in time to serve every area equally. It's better to implant them in not-so-sick patients in nearby hospitals, than to let the organs go to waste while trying to transport them across the continent. After an organ is obtained, the transplant coordinator first looks for potential patients in transplant centers served by the OPO. Virginia is in Region 11, with throughout Virginia, Kentucky, Tenneseee, North Carolina, and South Carolina. Region 2 consists of Maryland, New Jersey, Pennsylvania, and West Virginia.
The number of OPO's in a region is largely irrelevant Region 11 has 11 OPO's, Region 2 has only 4 - but it's the boundaries of the OPO that matters. Again, there is room for human judgement. Inova Fairfax Hospital in Northern Virginia may be in Region 11 with Sentara Norfolk General Hospital, but if you explore the Transplant Patient DataSource you'll see it's listed together in Region 2 reports with the Washington Hospital Center and nearby Johns Hopkins in Batlimore...
Because some regions of the country have fewer residents, they will have fewer donors. Patients in such an area could try to improve their odds of receiving an organ by getting a "multiple listing" at two or more hospitals, or moving to a hospital in another region with a greater supply. If you're near death, the costs of such a transfer may pale against the possibility of life. Of course, some patients in sparsely-populated areas will have a better chance because their area fewer transplant centers - and thus less demand, as well as less supply.
Supply and demand issues are typically resolved in our capitalist society by allowing businesses to set the price for goods and services, and ensuring customers have a choice of suppliers. It's considered unethical to sell human organs, however. In addition, unfettered capitalism is unrealistic when the Federal taxpayers are covering many of the costs.
Federal regulators and UNOS are struggling to eliminate efforts to "game the system" or provide advantages to just the wealthy, but at times are in conflict over proposed solutions. The Department of Health and Human Services, for example, is pressuring UNOS to reduce the disparities based on regional boundaries. In one OPO, the waiting list could be 5 times as long compared to another one.
The UNOS Rationale For Objectives of Equitable Organ Allocation states that "geographic and logistical concerns should be considered in the organ allocation system so that patients who cannot medically, physically, or financially afford to travel great distances to receive a transplant are not disadvantaged or denied access to transplantation."
Two of the three active OPO's in Virginia merged on May 1, 2000. LifeNet, based in Virginia Beach, absorbed the Virginia Organ Procurement Agency (VOPA). It now obtains organs from 75 hospitals in Charlottesville, Southwestern Virginia, and its original territory of eastern and central Virginia. The Health Care Finance Administration has also authorized the Washington Regional Transplant Consortium to serve as an OPO.
There are roughly 260 transplant centers in the country. According to the Transplant Patient DataSource, six centers transplanted hearts in Virginia in 1998:
Bone Marrow transplants are easier to describe, from a geographic perspective. Only one transplant facility, the Medical College of Virginia, is certified to participate with the National Marrow Donor Program. There are three donor centers in Virginia, in Norfolk, Richmond, and Roanoke. Northern Virginia donors can cross into DC or Maryland to contribute their marrow.