Analysis of the equity of emergency medical services: a cross-sectional survey in Chongqing city

Abstract

BackgroundAs a result of the economic reform and the uneven distribution of available wealth, equity of emergency medical services is at risk. This study aimed to assess the equity of emergency medical services in needs, utilisation, and distribution of resources, and to provide timely evidence for policy makers to improve such services in Chongqing city, China. MethodsWe obtained data for five variables of emergency needs—namely, maternal, neonatal, cerebrovascular, and cardiovascular mortality, and mortality from injury or poisoning—from the death surveillance and two utilisation variables (emergency room visits and rate of utilisation) from Chongqing Health Statistical Year Book 2008–12. We used a concentration index to assess equality in the distribution of needs and utilisation among three areas with different per-head gross domestic product (GDP). All districts in Chongqing city were divided into three areas by per-head GDP. In each area, we randomly chose two districts as sample areas and selected all the medical institutions with emergency services as subjects. Stratified, random, cluster sampling methods were used to link the emergency medical institutions in 2013, and we used the Gini coefficient to measure equity in demographic and geographical distribution of facilities and human resources related to emergency medical services. For each area, we also compared the needs and provision of such services. We obtained permission from the emergency medical institution and Chongqing Center for Disease Control and Prevention to use their data in this study. FindingsMaternal (concentration index range –0·213 to –0·096) and neonatal (–0·161 to –0·046) mortality declined in 2008–12 and was higher in low-income areas than in high-income areas. Maternal mortality was more inequitably distributed than neonatal mortality, and the gaps between high-income and low-income areas gradually became more noticeable. A steady improvement was recorded for cerebrovascular (0·106–0·455) and cardiovascular (0·101–0·329) mortality, and for mortality from injury or poisoning (0·001–0·301). The overall inequity of these mortalities was greater than those of maternal and neonatal mortalities, but distinct decreases were seen over the past 5 years. Patients in high-income areas were more likely to use emergency medical services (0·296–0·423) than those in low-income areas, and the concentration index increased over the 5-year period, suggesting that gaps in inequity were increasing. Distribution of facilities, physicians, and nurses were the least equitable. InterpretationIn Chongqing city, equity of needs, utilisation, and resource allocation of emergency medical services is low, and the provision of such services has not met the needs of patients. To reduce inequity, improvement in the ability of emergency medical services to decrease cerebrovascular cardiovascular mortality, and mortality from injury or poisoning, should be regarded as a top priority. In low-income areas, allocation of facilities and human resources needs to be improved. Because the quality of data reported varied among institutions, equity might have been underestimated. Furthermore, emergency room visits of maternal, neonatal, cerebrovascular, and cardiovascular problems and of injury or poisoning could not be extracted from the data, which could better reflect the utilisation of emergency medical services in these areas. FundingThis study was funded by the Chongqing Federation of Social Science Circles and Chongqing Department of Health and Family Planning Committee.