Access to emergency care services: a transversal ecological study about Brazilian emergency health care network

Studies of health geography are important in the planning and allocation of emergency health services. The geographical distribution of health facilities is an important factor in timely and quality access to emergency services; therefore, the present study analyzed the emergency health care network...

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Bibliographic Details
Published in:Public health (London) 2017-12, Vol.153, p.9-15
Main Authors: Rocha, T.A.H., da Silva, N.C., Amaral, P.V., Barbosa, A.C.Q., Rocha, J.V.M., Alvares, V., de Almeida, D.G., Thumé, E., Thomaz, E.B.A.F., de Sousa Queiroz, R.C., de Souza, M.R., Lein, A., Toomey, N., Staton, C.A., Vissoci, J.R.N., Facchini, L.A.
Format: Article
Language:English
Subjects:
Access to health services
Adult
Brazil
Child
Cross-Sectional Studies
Ecological monitoring
Ecological studies
Emergencies
Emergency health services
Emergency medical care
Emergency Medical Services
Emergency preparedness
Emergency services
Evaluation
Female
Geographical distribution
Geography
Health care
Health care facilities
Health disparities
Health services
Health Services Accessibility
Hospital facilities
Hospitals
Humans
Infant, Newborn
Intensive care
Municipalities
Neonates
Neonatology
Pediatrics
Polarization
Pregnancy
Rural areas
Rural communities
Spatial Analysis
Spatial distribution
Urban areas
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Summary:Studies of health geography are important in the planning and allocation of emergency health services. The geographical distribution of health facilities is an important factor in timely and quality access to emergency services; therefore, the present study analyzed the emergency health care network in Brazil, focusing the analysis at the roles of small hospitals (SHs). Cross-sectional ecological study. Data were collected from 9429 hospitals of which 3524 were SHs and 5905 were high-complexity centers (HCCs). For analytical purposes, we considered four specialties when examining the proxies of emergency care capability: adult, pediatrics, neonatal, and obstetric. We analyzed the spatial distribution of hospitals, identifying municipalities that rely exclusively on SHs and the distance of these cities from HCCs. More than 14 and 30 million people were at least 120 km away from HCCs with an adult intensive care unit (ICU) and pediatric ICU, respectively. For neonatal care distribution, 12% of the population was more than 120 km away from a health facility with a neonatal ICU. The maternities situation is different from other specialties, where 81% of the total Brazilian population was within 1 h or less from such health facilities. Our results highlighted a polarization in distribution of Brazilian health care facilities. There is a concentration of hospitals in urban areas more developed and access gaps in rural areas and the Amazon region. Our results demonstrate that the distribution of emergency services in Brazil is not facilitating access to the population due to geographical barriers associated with great distances. [Display omitted] •There are imbalances in emergency distribution of healthcare facilities in Brazil.•There is a concentration of hospitals in more developed areas.•There are access gaps in rural areas as well as in the Amazon region.•Rethinking the roles attributed to small hospitals can improve access to emergency services in Brazil.
ISSN:0033-3506
1476-5616
DOI:10.1016/j.puhe.2017.07.013