| ObjectiveWith the aged tendency of population and the rapid development of industry and transportation industry,the number of premature death and disability induced by cardiovascular and cerebrovascular diseases and accidental injuries,traffic accidents is increasing year by year,which seriously affects the potential health life loss of the population.At present,China has initially established EMSS with large and medium cities as the core,but the service levels among different regions are uneven,which restricts the further development of emergency medical services.Through the analysis of the second-hand data of the statistical yearbook,this study discusses the equity between the eastern,central and western areas of emergency medical services from three aspects of the patient's needs,utilization and resources distribution,so as to discuss the equity of emergency medical services in different areas with different economic development levels.In the further field investigation,Chongqing,Hubei and Jiangsu were selected as sampling areas.The distribution of medical staff,funds,equipment and facilities resources in three areas were analyzed in detail,and how the resources distribution factors affecting the equity of emergency medical treatment were discussed,so as to provide a reliable scientific basis for improving the equity of emergency medical services system.MethodThe Chinese Health Statistics Yearbook and the Chinese death cause monitoring data set were collected for the analysis of the second-hand data.The CI of the mortality of cardiovascular and cerebrovascular diseases,injury and digestive system diseases indicated the equity of the emergency medical needs between regions.The equity of emergency medical utilization between regions was expressed by the CI of emergency outpatient visits emergency utilization rate.The Gini coefficient of demographic and geographic distribution of emergency facilities represented the equity of resource allocation.In the field survey,Jiangsu,Hubei and Chongqing were selected as sample areas,and then 3 cities were extracted according to the economic development of high,middle and low level,and a total of 9 areas were used as the research ares.In each district,two second-class hospitals,two tertiary hospitals and a primary health care institution were selected.Finally,45 medical institutions were selected as the sampling sites.A questionnaire survey was conducted among the sampling hospitals,and qualitative interviews were conducted among health administrators,site administrators and first-aid medical personnel.Calibration check level card square test and constituent ratio analysis were used to count the collected data.Qualitative data were analyzed,arranged and extracted by Colaizzi seven step method.ResultFrom 2010 to 2014,the trend of mortality of cardiovascular and cerebrovascular diseases has shifted from economically developed areas to economically underdeveloped areas.The mortality rate of accidental injury and digestive system disease is always concentrated in economically underdeveloped areas,and regional inequalities are still existed.Emergency utilization rate is concentrated in economically developed areas,but equity has been in an improving status year by year.The Gini coefficients of emergency centers according to population distribution and area distribution are 0.0922 to 0.1200 and 0.5481 to 0.5696 respectively.The EMSS facilities distribution by population showed high equitability but the EMSS facilities distribution by geography suggested a huge gap between different ares.Among the 45 first aid medical sites surveyed,the age composition of Emergency medical staffs in Jiangsu province was older than that of Hubei province(X~2=19.955,P=0.001),and the age composition of Emergency medical staffs in Hubei province was older than that of Chongqing province(X~2=19.414,P=0.001);the educational background of emergency staff in Jiangsu was higher than that in Chongqing(X~2=23.991,P=0.000);there was no statistical significance(X~2=6.649,P=0.156)in the occupational title of emergency staffs in three areas of Chongqing,Hubei and Jiangsu.The work age of emergency staffs in Jiangsu was higher than that of Hubei province(X~2=24.507,P=0.000),and the work age of emergency staffs in Hubei province was higher than that of Chongqing(X~2=14.596,P=0.006).The composition ratio analysis can find that the proportion of first aid centers in Jiangsu and Hubei province was higher than that of Chongqing,and the configuration of emergency facilities in Jiangsu was generally better than Hubei Province,Hubei province was higher than Chongqing.Through the composition analysis,it was found that the proportion of Independent emergency site in Jiangsu and Hubei was higher than that of Chongqing,and the allocation rate of emergency equipment in Jiangsu was generally higher than that of Hubei and Hubei province was higher than that of Chongqing.The interview information are summarized and analyzed by Colaizzi method,and 5 themes are obtained:the top-level design of government,the construction of first-aid personnel,the configuration of vehicle equipment,the public welfare attributes of emergency medical care,and the sense of self-help and mutual help among the masses.ConclusionThe EMSS among the eastern,central and western regions of China is unfair,and the emergency medical service in the underdeveloped areas shows"high needs,low supply and low utilization".In the field investigation of Chongqing,Hubei and Jiangsu provinces,it was found that compared to Jiangsu and Hubei,the medical and nursing staff in Chongqing were younger,poorer educated and lack of work experience.The government of Chongqing has less funding investment,and the emergency sites are all established by local network hospitals,and the allocation rate of emergency equipment is low.It is necessary to implement the public welfare property of emergency medical treatment,increase government investment,improve the construction of the less developed areas,pay attention to the cultivation of emergency staffs and improve the allocation rate of emergencu equipment,so as to guarantee the basic rights and interests of the residents. |
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