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. 2017 Aug 22;16(1):149.
doi: 10.1186/s12939-017-0645-4.

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

Thiago Augusto Hernandes Rocha  1 , Núbia Cristina da Silva  2 , Pedro Vasconcelos Amaral  3 , Allan Claudius Queiroz Barbosa  4 , João Victor Muniz Rocha  5 , Viviane Alvares  2 , Dante Grapiuna de Almeida  6 , Elaine Thumé  7 , Erika Bárbara Abreu Fonseca Thomaz  8 , Rejane Christine de Sousa Queiroz  8 , Marta Rovery de Souza  9 , Adriana Lein  10 , Daniel Paulino Lopes  11 , Catherine A Staton  10 , João Ricardo Nickenig Vissoci  10 , Luiz Augusto Facchini  12
Affiliations

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

Thiago Augusto Hernandes Rocha et al. Int J Equity Health. .

Abstract

Background: Unequal 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.

Methods: The 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.

Results: The 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.

Conclusions: There 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.

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

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Conflict of interest statement

Ethics approval and consent to participate

The present study was carried out with ethical approval from the Committee on Ethics in Research (Comitê de Ética em Pesquisa) of the Federal University of Pelotas, number 546.012, (CAAE): 27,098,914.9.0000.5317.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Brazilian states, regions and hospital network
Fig. 2
Fig. 2
Distance among Small Hospitals (SH) and High Complexity Centers (HCC), in Brazil
Fig. 3
Fig. 3
Accessibility index for (a) Small Hospitals in Brazil. Darker colors mean higher cumulative accessibility to hospital beds rate by population
Fig. 4
Fig. 4
Accessibility index for High Complexity Centers in Brazil. Darker colors mean higher cumulative accessibility to hospital beds rate by population
Fig. 5
Fig. 5
Municipalities with above average access to SH and below average access to HCC considering the minimum emergency service requirements
Fig. 6
Fig. 6
Spatial association of adherence to MESR of municipalities in regions of above average access to SH and below average access to HCC
See this image and copyright information in PMC

References

    1. Kobusingye OC, Hyder AA, Bishai D, Hicks ER, Mock C, Joshipura M. Emergency medical systems in low- and middle-income countries: recommendations for action. Bull World Health Organ. 2005;83(8):626–631. - PMC - PubMed
    1. Clancy CM. Acute care quality improves while barriers to access remain: AHRQ’s 2012 healthcare quality and disparities reports. Am J Med Qual. 2013;28:443–5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23880776. [cited 23 Dec 2016]. - PubMed
    1. Ensor T, Cooper S. Overcoming barriers to health service access: influencing the demand side. Health Policy Plan. 2004;19:69–79. Available from: https://www.ncbi.nlm.nih.gov/pubmed/?term=Overcoming+barriers+to+health+.... [cited 23 Dec 2016]. - PubMed
    1. Jacobs B, Ir P, Bigdeli M, Annear PL, Van Damme W. Addressing access barriers to health services: an analytical framework for selectingappropriate interventions in low-income Asian countries. Health Policy Plan. 2012;27:288–300. doi: 10.1093/heapol/czr038. - DOI - PubMed
    1. Guagliardo MF. Spatial accessibility of primary care: concepts, methods and challenges. Int J Health Geogr. 2004;3:3. Available from: https://ij-healthgeographics.biomedcentral.com/articles/10.1186/1476-072.... - DOI - PMC - PubMed