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You don't think a your caveats are doing a lot of work here? How big is the weighting, and do they compare to vaccinating the young and healthy vs. the old and the infirm?
That's not a massive disproportion, and it says nothing about actual resource use. I've been to rural hospitals (in Europe) they're not comparable to city hospitals.
You don't think it's possible to patch someone up locally, and send them to a bigger hospital if they need more complex care? Or are you saying this is not being done?
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