Research On The Accessibility And Equity Of Emergency Medical Services In Chongqing

Objectives: With the aging population increasing and disease spectrum changing, as well as the rapid development of the transportation and industry, the number of casualties was increasing year by year. The main needs of emergency medical services(EMS) are from the patients caused by cardiovascular, disaster and accident. The aim of EMS is to provide acute intervention and timely health care to all patients with emergent or urgent problems, while the accessibility and equity were highlighted.Therefore, how to rational allocation EMS resources and improve the accessibility, we need targeted promote the equity. According to the present research, we first compared the accessibility of EMS and to reveal the regional disparities and inequitable, then comprehensively evaluate equity in EMS needs, utilisation and resources distribution to reveal the trend of the equity and the correlation of EMS needs and provision, and to provide feasible proposals to improve the equity and accessibility of EMS in Chongqing city, China.Methods: We used stratified random cluster methods, a total of 25 institutions of emergency ability in/out of networks in 6 sample areas weresurveyed, and the head of the executive branch, administrators and health service provider in each area were interviewed. The data of 5th National Health Service Survey in 2013, Chongqing Health Statistical Year Book2008 to 2013 were applied in this research. Descriptive analysis was used to analysis the accessibility of EMS. We used a concentration index to assess equality in the distribution of needs and utilization, the Gini coefficient to measure equity in population and geographic distribution of resources related EMS.Results:Firstly, the accessibility of EMS in ChongqingIn this study, we used the distribution of institutions, the time and distance of patients getting to the nearest health institutions, the allocation of human resources and equipments to assess the accessibility of EMS.Every one hundred thousand people in the lower economic level area(Ⅰand Ⅱ) and in the area Ⅲ with the highest economic level had 0.209,0.274 and 0.716 EMS institutions. Residents had to spend over 30 minutes to get to the nearest medical institutions was 24.28%, 17.79% and 7.50%,and the distance over 5 kilometer was 7.18%, 3.95% and 2.53%. In the three sample areas, every one thousand people had full-time emergency physicians were 0.010, 0.029 and 0.059, and nurses were 0.020, 0.077 and0.083, respectively. The number of the sickbeds of every one hundred thousand people was 3.80, 4.27 and 11.07. Of those 25 medical institutions,72.00% did not have cardiopulmonary resuscitation, hospital-bed and vehicular communication system on the ambulance. Chi-square test showed that the distribution of institutions in area Ⅲ was higher than that of institutions in area Ⅰand Ⅱ, and spent less time and distance getting to the nearest health institutions. Staffs in the sample area C with higher age and more time engaged in the work than that in area A and B, but equipped with less rescues beds.Secondly, the equity of EMS in ChongqingWe chose mortality rates of maternal, neonatal, cerebrovascular,cardiovascular, injury and poisoning cases as different needs indicators in EMS. Maternal-caused(CI: range-0.213 to-0.096) and neonatal-caused(CI: range-0.161 to-0.046) deaths declined in 2008–12, which focusing mainly on the lower economic level areas. The death of maternal was less equitably distributed, and the gaps between areas gradually become more noticeable. For cerebrovascular(CI: range 0.106 to 0.455), cardiovascular(CI: range 0.101 to 0.329) and injury or poisoning(CI: range 0.001 to0.301), we documented a steady improvement of mortality, the overall inequity of these mortalities was greater, but the disparity among areas significantly decreasing over time. The EMS utilisation indicators were emergency room visits and rates of utilization. The patients in high economic area were more likely to use EMS(CI: range 0.296 to 0.423),and the trends of inequity with an enlarged gap. The providing wasincluding facilities and human. The population distribution of facilities,physicians and nurses were 0.283, 0.310 and 0.187, representing more equitable than geographical.Conclusions: In Chongqing city, the equity of EMS needs, utilisation,and resources allocation is low, and the provision of such services has not met the needs of patients, the patients in the lower economic level area with higher needs of EMS were less likely to access emergency treatment.Meanwhile, there is a wide regional disparities in EMS institutions, human resources and equipments, it mainly displays in the irrational distribution of institutions and the capacity of EMS is not strong, such as lack of human resources and equipment, the short time of engaging in EMS work, et al.The main reasons of the disparities among regions are the heavy task, high risk, difficulties in promotion, low treatment and without extra subsidies,less establishments and the difference of financial. As a public welfare, the EMS should be given more financial support by the government to perfect the institutions, improve the emergency ability by strengthening the training, and provide the essential equipments in poor areas. To exert the function of ambulance feasibly, it should bring the expense of ambulance into the national health insurance to ensure human rights-life realized, and improve the accessibility and equity of EMS.