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Hospitals and policymakers routinely face a difficult question when investing in specialized emergency services: Will adding another facility improve care, or would those resources do more good somewhere else?

New UC San Francisco research suggests the answer depends heavily on what people already have access to. Among nearly 600,000 California heart attack patients, survival rates improved after specialized services opened in communities that previously lacked timely access. But where those services were already available, opening another facility increased the likelihood of receiving procedures only slightly and did not improve survival rates.

The findings highlight the importance of how limited health care resources are distributed. Adding capacity can produce significant benefits when it closes a critical access gap, the researchers found, while expanding services in communities that are already well served may do little to improve patient outcomes.

"Americans tend to think more is better, but where you put these services really matters," said Renee Y. , a UCSF professor of emergency medicine and senior author of the study. "Think of gas stations, for example. Adding another one in a neighborhood that already has five might make things a little more convenient. But if you put a gas station in an area where people previously had to drive 30 miles (48 kilometers) to find one, you're meeting a real need.

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