Future decision-making about health services should be strategic rather than based on who squeals the loudest, Otago District Health Board chairman Errol Millar says.
He made his comments at the board's monthly meeting this week during discussion on the draft report of the analysis of rural hospital capacity in Otago and Southland.
Deciding how money should be spent was not just a matter of looking at the total amount available and then dividing it by the number of people and "sprinkling it around" according to that, he said.
Socio-economic status had to be built in to the equation.
Chief executive Brian Rousseau said the report had shown that there were massive differences between various populations within the region.
People had to be careful they did not come to the wrong conclusion.
Oamaru might appear to have more service than an area such as Queenstown, but the socio-economic status was different.
Some service provision had been driven by demand, but some had been driven by communities lobbying for funding and some communities had been more successful than others in that.
When population figures had changed, funding had not shrunk to match the drop in population.
There was inequity in terms of access to emergency departments around the region and it could be seen that different models of care changed attendance figure totals.
Dunstan and Balclutha hospitals, where patients attended only after being seen in the community, had lower attendance rates.
Mr Rousseau agreed with members' comments that the figures for Dunedin and Invercargill hospitals needed to be included to give a full picture and it would not be difficult to include that information.
Dunedin Hospital had yearly emergency department attendances of about 37,000 for a population of 110,000 and Invercargill about 32,000 for a population of 45,000.
These figures were "way out of line" with what had been achieved in Dunstan and Balclutha.
Mr Rousseau said he was not expecting huge changes to the analysis when the report was finalised later this month. At that time, work would begin on looking at possible alternative ways of providing care.
"The easy bit is over," he said.
The report found bed numbers in rural Otago and Southland were adequate until 2026 and could be reduced by treating more people in the community.
It suggested hospital admissions could be reduced by 30%, but it would require changes to the way services were provided and greater integration of them.
Otago and Southland boards are also to work together on their health needs assessment, which will be used to develop the three-yearly district strategic plan for the two areas.
This has to be completed next year.