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Spatial Accessibility to Emergency Care in Sichuan Province in China

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Spatial Accessibility to Emergency Care in Sichuan Province in China gh-2020_2 DEF.qxp_Hrev_master 14/01/21 23:37 Pagina 274 Geospatial Health 2020; volume 15:891 Spatial accessibility to emergency care in Sichuan province in China Xuefeng Tang,1,2 Yufan Deng,3,4 Huazhen Yang,3 Fan Tian,3,4 Youping Li,1 Jay Pan3,4 1West China School of Medicine and Chinese Evidence-based Medicine Center; 2Sichuan Center for Disease Control and Prevention; 3West China School of Public Health and West China Fourth Hospital, Sichuan University; 4West China Research Center for Rural Health Development, Sichuan University, Chengdu, China area presenting much better accessibility than the western area. Abstract Regression results suggested that county-level discrepancies with Timely access to emergency care, which still remains insuffi- respect to accessibility could be significantly attributed to vari- cient in China, can substantially improve overall health outcomes. ance in local economic development, urbanization level and A better understanding of emergency care from the perspective of administrative area. These findings indicate that long-term efforts spatial accessibility is essential for future healthcare planning. need to be made by the central government in China optimizing This study provides a brief introduction to the emergency medical allocation of healthcare resources, as well as fortifying financial service system of China assessing the spatial accessibility of emer- support and providing preferential policies for economically dis- gency care and associated social-economic characteristics in advantaged regions. Sichuan province. Based on demographic and hospital administra- only tive data in 2018, we measured the spatial accessibility employing the nearest-neighbour method and identified associated social- economic factors by the conventional Ordinary Least Square Introduction (OLS) approach. Travel time analysis revealed a relatively high As a fundamentaluse part of public health resource, emergency level of overall spatial accessibility to emergency care in Sichuan. care refers to the health system capacity required to ensure effec- However, substantial geographical disparity in accessibility could tive, efficient provision of curative services for emergent health nevertheless be observed throughout the province, with the eastern events (Calvello et al., 2013). These events include a diverse set of acute conditions which should normally be treated at high-level healthcare facilities, with trauma, obstetric and surgical conditions being the most common examples. Without timely emergency Corrispoindence: Youping Li, West China School of Medicine and Chinese Evidence-based Medicine Center, Sichuan, Chengdu 610041, care, patients would possibly face a poor prognosis and even death China. (Bhutta et al., 2014; Gauss et al., 2019; Tansley et al., 2019). In E-mail: [email protected] fact, emergent conditions have become major contributors to mor- tality and disability rates in low and middle-income countries Key words: Spatial accessibility; emergency care; nearest neighbour (Lopez and Murray, 1998; Norton and Kobusingye, 2013), where method; ordinary least square (OLS) method; China. the paucity of emergency care resources remains a crucial prob- lem. The improvement of accessibility, availability and quality of Acknowledgements: We thank the National Natural Science timely emergency care has long been addressed and advocated Foundation of China (Grant No. 71874116), Ministry of Education of throughout a worldwide range. In 2007, the World Health China (Grant No. 18YJA790062), Chengdu Federation of Social Assembly (WHA) proposed Resolution 60.22, which addresses Science Association (Grant No. ZZ05),Non-commercial Sichuan University (Grant No. 2018SCUH0027 and SKSYL201811), and China Medical Board (Grant the lack of emergency care as a worldwide healthcare issue, espe- No. 17-276) for their financial support. We would also thank Yili Yang cially in rural and urban communities of low and middle-income for her language proofreading, Yun Yin and Yingzhe Zhang for their countries (WHA, 2007). According to a proposal advocated in preliminary research assistance. 2015 (Meara et al., 2015), a minimum of 80% coverage of emer- gency surgical and anaesthesia services per country should be Conflict of interests: The authors declare no potential conflict of interests. guaranteed in order to achieve universal access to essential medi- cal services. Received for publication: 24 April 2020. To understand the provision of emergency care, an accurate Accepted for publication: 9 July 2020. assessment of current resources and a detailed knowledge of pop- ulations’ access to these resources are required. Access to health- ©Copyright: the Author(s), 2020 Licensee PAGEPress, Italy care can be evaluated in various ways (Guagliardo, 2004), with Geospatial Health 2020; 15:891 spatial accessibility being recognized as an important component doi:10.4081/gh.2020.891 in the evaluation of a population’s overall access to healthcare (Berke and Shi, 2009). Since the time needed to reach medical This article is distributed under the terms of the Creative Commons care is considered a key performance indicator of emergency care, Attribution Noncommercial License (CC BY-NC 4.0) which permits any distance to the nearest provider has been widely adopted in mea- noncommercial use, distribution, and reproduction in any medium, pro- suring spatial accessibility to emergency care. Other measuring vided the original author(s) and source are credited. methods, such as the provider-to-population ratio and gravity [page 274] [Geospatial Health 2020; 15:891] gh-2020_2 DEF.qxp_Hrev_master 14/01/21 23:37 Pagina 275 Article models, are used less often in this field of research. Although ity as well as providing evidence-based implications for future pol- assessments of spatial accessibility to emergency care have been icymaking and medical resource allocation. carried out in several countries (Tansley et al., 2015; Juran et al., 2018; Khubchandani et al., 2018; Ouma et al., 2018; Nishikawa et Emergency medical service system in China al., 2019), most studies focused on the poor spatial accessibility The embryo of China’s emergency healthcare system dates resulting from regional resource scarcity, with less attention paid to back to the 1950s, with its rapid development evident from the list inter- and intra-regional inequities. It is therefore noteworthy that of opinions on strengthening urban emergency care announced by Universal Health Coverage (UHC), one of the fundamental goals the Chinese Ministry of Health (1980). Such development brought of regional equity, should receive equal attention in the evaluation about progressive establishment of first-aid stations (sub-stations) process. in urban regions in order to provide field first-aid and patient trans- China, the largest developing country in the world, provides an fer services, while the Medical Institution Management example of a country facing challenges of uneven distributions of Regulations was issued in the next decade by the Chinese Ministry healthcare resources (including emergency healthcare resources). of Health (1994), which made it mandatory for hospitals to set up This situation is of high public concern in China and has become emergency rooms or emergency departments according to their one of the major tasks for healthcare reform. Although the health- levels. Currently, the entire procedure of emergency care in China care system has been improved substantially since the initiation of covers both pre-hospital and in-hospital emergency care, which a new round of national health system reform in 2009, distinctive reflects the remarkable improvement of China’s emergency health- regional disparities in healthcare resources, especially those tack- care system over the past decades. ling certain medical conditions, still remain neglected (Shen et al., The providers of emergency care in China can be classified 2014; Liu et al., 2015; Pan et al.,. 2016; Zhang et al., 2017; Wu, into three categories: emergency centres, hospitals and primary 2018). Meanwhile, inadequate studies have been conducted for healthcare institutions with 24-hour emergency medical services evaluating access to emergency care in China. A better understand- (Figure 1). City hospitalsonly and community health centres (CHCs) ing of emergency care from the perspective of spatial accessibility constitute the urban emergency healthcare system, while the rural is therefore desperately needed in order to provide suggestions for part comprises county hospitals and township health centres future policymaking. (THCs). In this study, we first provide a brief introduction to China’s The basicuse responsibility of an emergency centre is to provide emergency medical service system using Sichuan Province as an management services such as ambulance dispatching and tele- example calculating the spatial accessibility to emergency care as phone advice. However, in order to conform to regional character- reflected by the time needed for getting to the nearest healthcare istics in China, different development strategies have been applied provider available. We further aimed to explore social-economic by local governments, bringing about various types of emergency determinants to spatial accessibility at the county level as the find- centres. Depending on their responsibilities, emergency centres ings were expected to depict the emergency healthcare accessibil- can be classified into four classes: i) The command type, which Non-commercial
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