Access to emergency hospitals A GEOSTAT 1B case study GISCO - WORKING PARTY MEETING, 18th and 19th of March 2014

GISCO - WORKING PARTY MEETING, Aim and relevance Aim: To demonstrate the advantages of grid statistics To analyse the population’s geographical access to emergency hospitals divided by age-groups and sex Relevance: A potential complement to The European Core Health Indicators (ECHI) indicator 80: Equity of access to health care services May result in improved understanding of ECHI survey results Can improve existing surveys GISCO - WORKING PARTY MEETING, 18th and 19th of March 2014

Emergency Medical Services Emergency Medical Services (EMS) include Emergency Hospitals and pre-hospital care (on-site care and transport) vary in between countries Emergency Hospitals (EH) Can have an important role in the pre-hospital care as a center for ambulance vehicles, staff and communication Figure 1. An example of an EMS framework GISCO - WORKING PARTY MEETING, 18th and 19th of March 2014

Partners’ understanding of EH The partners have defined emergency hospitals as a medical care center handling so called in-patience. That will say hospitals that can have patience overnight. Bulgaria has also included ambulance services and is therefore not comparable. Czech Republic 136 hospitals with intensive care units and internal or cardiology departments. Selected out of 184 hospitals with beds for acute care (excluding narrowly specialized or detached establishments) Estonia 19 hospitals providing emergency care (included in the Estonian “Hospital Master Plan” and not ambulance stations) Finland 56 hospitals’ and health centres’ emergency rooms with 24/7 service (excluding “mobile emergency rooms” in the northern part of Finland) Norway 44 hospitals with emergency rooms (excluding pre-hospital services as ambulance services, emergency medical communication centres and emergency clinics “legevakt”) Bulgaria 28 Centers for Emergency Health Care and regional branches in the smaller towns (in most cases the municipality centers) including medical teams with equipped vehicles GISCO - WORKING PARTY MEETING, 18th and 19th of March 2014

GISCO - WORKING PARTY MEETING, Methodology Data used: Emergency hospitals 1km x 1km grids and municipalities including population data divided by age groups and sex Road network including information about speed limits Process: 1. Establish a map with service areas based on 30-minute travelling distances from or to emergency hospitals 2. Intersect the service area with 1km x 1km grids and municipalities including population data 3. Sum up the population for the individual age groups by sex and for the total population 3. Compare results on grids with results on municipality units GISCO - WORKING PARTY MEETING, 18th and 19th of March 2014

Advantages of using grids GISCO - WORKING PARTY MEETING, 18th and 19th of March 2014

GISCO - WORKING PARTY MEETING, 18th and 19th of March 2014 Results: Bulgaria GISCO - WORKING PARTY MEETING, 18th and 19th of March 2014

Results: Czech Republic GISCO - WORKING PARTY MEETING, 18th and 19th of March 2014

GISCO - WORKING PARTY MEETING, Results: Estonia GISCO - WORKING PARTY MEETING, 18th and 19th of March 2014

GISCO - WORKING PARTY MEETING, Results: Finland GISCO - WORKING PARTY MEETING, 18th and 19th of March 2014

GISCO - WORKING PARTY MEETING, Results: Norway GISCO - WORKING PARTY MEETING, 18th and 19th of March 2014

Access to emergency hospitals GISCO - WORKING PARTY MEETING, 18th and 19th of March 2014

GISCO - WORKING PARTY MEETING, About the results This case study proves the strengths of grid statistics The main differences in between the countries in this accessibility study lie in: Geographical coverage of emergency hospitals and is partly explained by differences in defining Emergency hospitals Population distribution Size and the physical geography (e.g. hilliness, coastline, lakes) of the countries Road network (incl. coverage and speed limits) GISCO - WORKING PARTY MEETING, 18th and 19th of March 2014

GISCO - WORKING PARTY MEETING, Further work To assess the equity of geographical access to health care services (ECHI) this study needs to: agree on how to define Emergency hospitals based on Emergency Medical Services (EMS) in all European countries include traffic load as limiting factor for the accessibility include emergency transports by helicopter, plane or and boat when generating Service Areas add an additional service area with a lower driving time distance Consequences of applying different confidentiality thresholds However, this might give a better understanding of why the ECHI interviewees reply differently based on nationality GISCO - WORKING PARTY MEETING, 18th and 19th of March 2014