Insurers and health-tech vendors face a 1.45bn-person emergency care gap

In an arXiv preprint (version 1) dated September 2026, researchers map drive-time access to hospitals worldwide and draw a line most healthcare operators will recognize from experience: being near any hospital is not the same as being near emergency care. The paper routes travel time on the OpenStreetMap network from 217,841 facilities, constructs 15-, 30- and 60-minute isochrones for nested capability tiers, and weights the results with the GHS-POP 2025 population grid. Its headline figures are blunt. It estimates 96.2% of the world’s population lives within an hour of a hospital, 78.5% within an hour of a hospital with a documented emergency department, and 40.3% within an hour of a tertiary-like site (proxied by a helipad or a university name). The authors add that 1.45 billion people are within an hour of a hospital but not an emergency hospital, concentrated in South and East Asia and Nigeria, and 312 million lie beyond an hour of any hospital in a band from the Sahel to Madagascar. The preprint argues that counting every facility as equivalent overstates access to time-critical care. This is a single-source research preprint, not peer-reviewed and not independently verified; no one in the reported packet is on the record.

The emergency-capable denominator is smaller than network-adequacy dashboards assume

Health plans, employer benefits teams and hospital networks typically report facility counts and average distances to satisfy network adequacy rules and to market coverage. The preprint’s tiered cut suggests that those dashboards conflate access to buildings with access to stabilization and definitive care. If 96.2% are within an hour of any hospital but only 78.5% of one with an emergency department, then the denominator for time-critical conditions is roughly a fifth smaller than many “in-network access” lines imply. For tertiary-like care, the gap is larger: at 40.3%, less than half of the population is within an hour of a site that plausibly handles complex emergencies. For operators, that reframes where coverage and capacity are credible — and where they are not — with direct consequences for how network adequacy is priced, how provider directories are marketed, and how dispatch and referral software is bought.

For sales teams, the 1.45bn-person grey zone is the demand map for triage, transport and virtual front doors

The most commercially relevant figure in the preprint is not the global 96.2% headline but the 1.45 billion people within an hour of a hospital but not one with an emergency department. That “grey zone” defines where triage, stabilization and transfer workflows create real risk for payers and providers — and, therefore, real budget for vendors who can compress time-to-care without claiming to replace it. Tele-triage platforms, referral and capacity management tools, ambulance dispatch and routing systems, and inventory visibility for oxygen and blood all sell on the same metric in these geographies: minutes saved to an emergency-capable site. Drone delivery and community paramedicine programs also live or die on that clock. Sales motions that currently lead with “facility coverage” should be re-cut to lead with a before/after map of 30- and 60-minute isochrones by emergency-capable tier, because this is the unit the preprint exposes and the risk owners recognize.

Procurement will start asking for tiered access metrics, not facility counts or unsegmented drive-time averages

If you sell to payers, ministries, or hospital networks, expect RFPs to get more explicit. The preprint’s method — OpenStreetMap-based routing, nested isochrones at 15/30/60 minutes, population weighting, and tiering by emergency department documentation and helipad/university proxies — is publishable and replicable. That makes it easy for buyers to specify. Instead of “80% of members within 30 minutes of care,” expect to see “80% within 30 minutes of an emergency-capable hospital, as evidenced by directory-level ED documentation; 50% within 60 minutes of a tertiary-like site.” Dispatch and referral software vendors will be asked to show SLAs and route-optimization gains on that tiered basis. Network-design consultants will be asked to produce coverage deltas by tier before a clinic build or a hospital affiliation is approved. For marketing teams, that means replacing generic heat maps with tiered access layers and being precise about which tiers your solution actually improves.

The data is open, useful and imperfect — treat the estimates as a floor, not a victory lap

Operators should read the caveats in the same paragraph as the numbers. The preprint relies on volunteer-mapped OpenStreetMap hospital points and road networks; coverage and attribute completeness vary by region. The emergency department tier depends on whether an ED is documented at the facility level; documentation practices differ and may lag reality. The tertiary-like tier is proxied by a helipad or a university name; the authors note that defining the tertiary tier by helipad alone leaves its estimate unchanged, which helps, but it is still a proxy rather than a credentialed capability. Isochrone construction shifts the 60-minute figures by a few percent depending on methodological choices, and the population weighting uses GHS-POP 2025, itself a model. All of this argues for caution in using single digits as scorecard targets and for framing the estimates as conservative floors. If anything, in places where OSM attributes are sparse, true emergency-capable access may be worse than reported — which strengthens, not weakens, the case for measuring by tier.

Retail clinics, primary care networks and virtual care don’t substitute for emergency capability in the metrics that matter

The tiered cut also clarifies something the industry often muddies in marketing: building more primary care or outpatient capacity is valuable, but it does not move the emergency-capable denominator unless those sites add ED-grade staffing, equipment and transport links. In markets where retail clinics and community health centers are expanding, their impact on time-to-emergency is realized primarily through faster triage-to-transfer and better pre-arrival stabilization, not through proximity alone. Vendors selling virtual first-contact models should stop claiming “access solved” and start quantifying “time to ambulance activation reduced” and “transfer acceptance time reduced” relative to the 30- and 60-minute isochrones the preprint sets out. Buyers, in turn, should pay for measured gains on those clocks, not for generic utilization shifts.

The belt beyond an hour of any hospital is a capital-planning problem first, but software still has a job

The 312 million people beyond an hour of any hospital cluster in a band from the Sahel to Madagascar. That is primarily an infrastructure and staffing story, not a software one. But even there, the preprint’s routable, tiered approach lets funders and operators plan EMS outposts, aeromedical bases and referral corridors with a concrete objective function. In capital cycles where new bricks are years away, procurement can still move: oxygen and blood inventory visibility at peripheral sites, tele-triage that triggers transfer earlier, and dispatch software tuned for long-haul transfers. For development finance and global health buyers, the preprint gives an open-method baseline for assessing whether a grant or loan actually improves the metric that matters: reducing the population outside 60 minutes of emergency-capable care.

What changes first inside buyer organizations

Inside health plans and provider networks, expect two near-term moves. First, actuarial and clinical quality teams will re-cut risk by urgent condition against the tiered access map rather than a general “within X minutes of a hospital” line. That changes where care-management programs launch and which members get navigation support. Second, network management will push directory clean-up on emergency department attributes; if ED documentation is the gating factor for the 78.5% figure, making facility metadata accurate is now a financial exercise, not just a compliance chore. For software buyers, that means procurement will privilege vendors who can ingest OSM and local facility attributes, maintain isochrone models, and express SLAs and outcomes on a tiered-access basis.

Read the preprint as a specification for your next pitch deck and your next RFP

Because the method is open and cited, it doubles as a de facto spec. Sales teams should show before/after maps of 15/30/60-minute access to emergency-capable hospitals for the specific geography and population their buyer cares about. Product teams should make tiered-access a standard dashboard cut. Buyers should require vendors to use the same inputs (OSM network, facility-level ED attributes, consistent isochrone settings, GHS-POP 2025 or successor) so competing claims are comparable. And both sides should acknowledge the limitations the authors name, including sensitivity of the 60-minute band to modelling choices — then show that their decision logic is robust to those few-percent swings.

The preprint’s most important commercial contribution is not the exact percentages but the framing: access-to-what, within-how-many-minutes, for-how-many-people. If facility-count marketing survived because the denominator was fuzzy, this paper removes that excuse. Even if peers or regulators are not yet asking for tiered emergency access, the buyers who own the risk will. Vendors who can prove they shrink the 1.45 billion-person grey zone — measured by minutes, not impressions — will find budgets. Those still selling against a building count will find their claims discounted.