1. Access to emergency hospitals A GEOSTAT 1B case study EFGS Conference 2013 24th October Sofia, Bulgaria

2. 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

3. Emergency Medical Services Emergency Medical Services (EMS) -include Emergency Hospitals (EH) and pre-hospital care (on-site care and transport) -vary in between countries EH ­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

4. Partners’ understanding of EH 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

5. 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

6. Advantages of using grids

7. Results: Bulgaria

8. Results: Czech Republic

9. Results: Estonia

10. Results: Finland

11. Results: Norway

12. Access to emergency hospitals

13. 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)

14. 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 each country 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