Urban-sub-urban-rural variation in the supply and demand of emergency medical services

Abstract

Background: Emergency medical services (EMSs) are a critical component of health systems, often serving as the first point of contact for patients. Understanding EMS supply and demand is necessary to meet growing demand and improve service quality. Nevertheless, it remains unclear whether the EMS supply matches the demand after the 2016 healthcare reform in China. Our objective was to comprehensively investigate EMS supply-demand matching, particularly among urban vs. sub-urban vs. rural areas.

Methods: Data were extracted from the Tianjin Medical Priority Dispatch System (2017-2021). From supply and demand perspectives, EMS resources and patient characteristics were analyzed. First, we performed a descriptive analysis of characteristics, used Moran's I to explore the spatial layout, and used the Gini coefficient to evaluate the equity of EMS supply and demand. Second, we analyzed urban-sub-urban-rural variation in the characteristics of EMS supply and demand by using the chi-square test. Finally, we examined the association between the EMS health resource density index and the number of patients by using the Spearman correlation and divided supply-demand matching types into four types.

Results: In 2021, the numbers of medical emergency stations and ambulances were 1.602 and 3.270 per 100,000 population in Tianjin, respectively. There were gradients in the health resource density index of the number of emergency stations (0.260 vs. 0.059 vs. 0.036; P = 0.000) in urban, sub-urban, and rural areas. There was no spatial autocorrelation among medical emergency stations, of which the G values by population, geographical distribution, and the health resource density index were 0.132, 0.649, and 0.473, respectively. EMS demand was the highest in urban areas, followed by sub-urban and rural areas (24.671 vs. 15.081 vs. 3.210 per 1,000 population and per year; P = 0.000). The EMS supply met the demand in most districts (r = 0.701, P = 0.003). The high supply-high demand types with stationary demand trends were distributed in urban areas; the low supply-high demand types with significant demand growth trends were distributed in sub-urban areas; and the low supply-low demand types with the highest speed of demand growth were distributed in rural areas.

Conclusion: EMS supply quantity and quality were promoted, and the supply met the demand after the 2016 healthcare reform in Tianjin. There was urban-sub-urban-rural variation in EMS supply and demand patterns.

Keywords: emergency medical services; healthcare reform; healthcare resources; megacity; supply and demand matching.

Figure 1

Number of medical emergency stations, PEPs, and nurses in Tianjin. PEPs, prehospital emergency physicians.

Figure 2

Equity in EMS supply in Tianjin. HRDI, health resource density index. The orange font represents urban areas (Heping, Hexi, Hedong, Nankai, Hebei, and Hongqiao districts); the blue font represents sub-urban areas (Dongli, Xiqing, Jinnan, and Beichen districts); and the green font represents rural areas (Baodi, Wuqing, Ninghe, Jinghai, Jixian, and Binhai districts).

Figure 3

Process of EMS utilization in Tianjin. ^†Step 1 and Step 2 were implemented simultaneously in 2021. ^§The ambulances were directly dispatched by the municipal emergency medical center in urban and sub-urban areas; the rural implemented regional ambulances dispatched by the emergency medical subcenter. ^#Some EMS utilization was transportation from one hospital. Response time = ⑤-①.

Figure 4

Geographical distribution and APC of EMS patients in Tianjin. (A) The number of patients using EMS in 2017; (B) the number of patients using EMS in 2018; (C) the number of patients using EMS in 2019; (D) the number of patients using EMS in 2020; (E) the number of patients using EMS in 2021; (F) APC of EMS patients in Tianjin from 2017 to 2021.

Figure 5

Supply–demand matching pattern of EMS at different levels in Tianjin. Urban areas include Heping, Hexi, Hedong, Nankai, Hebei, and Hongqiao districts. Sub-urban areas include Dongli, Xiqing, Jinnan, and Beichen districts. Rural areas include Baodi, Wuqing, Ninghe, Jinghai, Jixian, and Binhai districts.