Addressing geographic access barriers to emergency care services: a national ecologic study of hospitals in Brazil

International Journal for Equity in Health

Research

Thiago Augusto Hernandes Rocha¹  Pedro Vasconcelos Amaral²  Allan Claudius Queiroz Barbosa³  Daniel Paulino Lopes⁴  Elaine Thumé⁵  Marta Rovery de Souza⁶  Rejane Christine de Sousa Queiroz⁷  Erika Bárbara Abreu Fonseca Thomaz⁷  João Ricardo Nickenig Vissoci⁸  Catherine A. Staton⁸  Adriana Lein⁸  Luiz Augusto Facchini⁹  Dante Grapiuna de Almeida^1,10  João Victor Muniz Rocha^1,11  Viviane Alvares^1,12  Núbia Cristina da Silva^1,12 

[1] Center of post-graduate and Research in Administration, School of Economics, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil;Centre for Development and Regional Planning, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil;Department of Administrative Sciences, Faculty of Economics, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil;Department of Applied Social Sciences, Federal Center of Technological Education CEFET-MG, Belo Horizonte, Minas Gerais, Brazil;Department of Collective Health, Faculty of Nursing, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil;Department of Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil;Department of Public Health, Federal University of Maranhão, São Luís, Maranhão, Brazil;Division of Emergency Medicine, Duke University Health System, Duke Global Health Institute, Duke University, Durham, USA;Faculty of Medicine, Departament of social Medicine, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil;Medomai information technology, Belo Horizonte, Minas Gerais, Brazil;National School of Public Health, Nova University, Lisbon, Portugal;Observatory of Human Resources in Health, Faculty of Economics, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil;

关键词: Spatial analysis;    Hospitals;    Health care evaluation mechanisms;    Emergency health services;    Health services accessibility;    Rural hospitals;    Low-volume hospitals;    Spatial autocorrelation;   

DOI  :  10.1186/s12939-017-0645-4

 received in 2017-02-16, accepted in 2017-08-10,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundUnequal distribution of emergency care services is a critical barrier to be overcome to assure access to emergency and surgical care. Considering this context it was objective of the present work analyze geographic access barriers to emergency care services in Brazil. A secondary aim of the study is to define possible roles to be assumed by small hospitals in the Brazilian healthcare network to overcome geographic access challenges.MethodsThe present work can be classified as a cross-sectional ecological study. To carry out the present study, data of all 5843 Brazilian hospitals were categorized among high complexity centers and small hospitals. The geographical access barriers were identified through the use of two-step floating catchment area method. Once concluded the previous step an evaluation using the Getis-Ord-Gi method was performed to identify spatial clusters of municipalities with limited access to high complexity centers but well covered by well-equipped small hospitals.ResultsThe analysis of accessibility index of high complexity centers highlighted large portions of the country with nearly zero hospital beds by inhabitant. In contrast, it was possible observe a group of 1595 municipalities with high accessibility to small hospitals, simultaneously with a low coverage of high complexity centers. Among the 1595 municipalities with good accessibility to small hospitals, 74% (1183) were covered by small hospitals with at least 60% of minimum emergency service requirements. The spatial clusters analysis aggregated 589 municipalities with high values related to minimum emergency service requirements. Small hospitals in these 589 cities could promote the equity in access to emergency services benefiting more than eight million people.ConclusionsThere is a spatial disequilibrium within the country with prominent gaps in the health care network for emergency services. Taking this challenge into consideration, small hospitals could be a possible solution and foster equity in access to emergency and surgical care. However more investments in are necessary to improve small hospitals capabilities to fill this gap.

【 授权许可】

CC BY   
© The Author(s). 2017