T A H Rocha1, N C da Silva2, P V Amaral3, A C Q Barbosa4, J V M Rocha5, V Alvares6, D G de Almeida7, E Thumé8, E B A F Thomaz9, R C de Sousa Queiroz10, M R de Souza11, A Lein12, N Toomey13, C A Staton14, J R N Vissoci15, L A Facchini16. 1. Federal University of Minas Gerais, School of Economics, Center of Post-graduate and Research in Administration Belo Horizonte, Minas Gerais, Brazil. Electronic address: rochahernandes3@gmail.com. 2. Federal University of Minas Gerais, Faculty of Economics, Observatory of Human Resources in Health, Belo Horizonte, Minas Gerais, Brazil. Electronic address: nubiacristina@gmail.com. 3. Federal University of Minas Gerais, Centre for Development and Regional Planning, Minas Gerais, Brazil. Electronic address: pedroamaral@cedeplar.ufmg.br. 4. Federal University of Minas Gerais, Faculty of Economics, Department of Administrative Sciences, Belo Horizonte, Minas Gerais, Brazil. Electronic address: allan@ufmg.br. 5. Federal University of Minas Gerais, Faculty of Economics, Observatory of Human Resources in Health, Belo Horizonte, Minas Gerais, Brazil. Electronic address: joao096victor@gmail.com. 6. Federal University of Minas Gerais, Faculty of Economics, Observatory of Human Resources in Health, Belo Horizonte, Minas Gerais, Brazil. Electronic address: viviane_alvares@yahoo.com.br. 7. Medomai Information Technology, Belo Horizonte, Minas Gerais, Brazil. Electronic address: dante@medomai.com.br. 8. Federal University of Pelotas, Faculty of Nursing, Department of Collective Health, Pelotas, Rio Grande do Sul, Brazil. Electronic address: elainethume@gmail.com. 9. Federal University of Maranhão, Department of Public Health, São Luís, Maranhão, Brazil. Electronic address: ebthomaz@globo.com. 10. Federal University of Maranhão, Department of Public Health, São Luís, Maranhão, Brazil. Electronic address: queiroz.rejane@gmail.com. 11. Federal University of Goiás, Department of Public Health, Goiânia, Goiás, Brazil. Electronic address: martary@gmail.com. 12. Duke Global Health Institute, Duke University, USA. Electronic address: adriana.lein@duke.edu. 13. Duke University Medical Center, Department of Surgery, Division of Emergency Medicine, Duke University, NC, USA. Electronic address: nicole.toomey@duke.edu. 14. Duke Global Health Institute, Duke University, USA; Division of Emergency Medicine, Duke University Health System, Duke Global Health Institute, Duke University, NC, USA. Electronic address: catherine.lynch@duke.edu. 15. Division of Emergency Medicine, Duke University Health System, Duke Global Health Institute, Duke University, NC, USA. Electronic address: jnv4@duke.edu. 16. Federal University of Pelotas, Faculty of Medicine, Department of Social Medicine, Pelotas, Rio Grande do Sul, Brazil. Electronic address: luizfacchini@gmail.com.
Abstract
OBJECTIVES: Studies of health geography are important in the planning and allocation of emergency health services. The geographical distribution of health facilities is an important factor in timely and quality access to emergency services; therefore, the present study analyzed the emergency health care network in Brazil, focusing the analysis at the roles of small hospitals (SHs). STUDY DESIGN: Cross-sectional ecological study. METHODS: Data were collected from 9429 hospitals of which 3524 were SHs and 5905 were high-complexity centers (HCCs). For analytical purposes, we considered four specialties when examining the proxies of emergency care capability: adult, pediatrics, neonatal, and obstetric. We analyzed the spatial distribution of hospitals, identifying municipalities that rely exclusively on SHs and the distance of these cities from HCCs. RESULTS: More than 14 and 30 million people were at least 120 km away from HCCs with an adult intensive care unit (ICU) and pediatric ICU, respectively. For neonatal care distribution, 12% of the population was more than 120 km away from a health facility with a neonatal ICU. The maternities situation is different from other specialties, where 81% of the total Brazilian population was within 1 h or less from such health facilities. CONCLUSION: Our results highlighted a polarization in distribution of Brazilian health care facilities. There is a concentration of hospitals in urban areas more developed and access gaps in rural areas and the Amazon region. Our results demonstrate that the distribution of emergency services in Brazil is not facilitating access to the population due to geographical barriers associated with great distances.
OBJECTIVES: Studies of health geography are important in the planning and allocation of emergency health services. The geographical distribution of health facilities is an important factor in timely and quality access to emergency services; therefore, the present study analyzed the emergency health care network in Brazil, focusing the analysis at the roles of small hospitals (SHs). STUDY DESIGN: Cross-sectional ecological study. METHODS: Data were collected from 9429 hospitals of which 3524 were SHs and 5905 were high-complexity centers (HCCs). For analytical purposes, we considered four specialties when examining the proxies of emergency care capability: adult, pediatrics, neonatal, and obstetric. We analyzed the spatial distribution of hospitals, identifying municipalities that rely exclusively on SHs and the distance of these cities from HCCs. RESULTS: More than 14 and 30 million people were at least 120 km away from HCCs with an adult intensive care unit (ICU) and pediatric ICU, respectively. For neonatal care distribution, 12% of the population was more than 120 km away from a health facility with a neonatal ICU. The maternities situation is different from other specialties, where 81% of the total Brazilian population was within 1 h or less from such health facilities. CONCLUSION: Our results highlighted a polarization in distribution of Brazilian health care facilities. There is a concentration of hospitals in urban areas more developed and access gaps in rural areas and the Amazon region. Our results demonstrate that the distribution of emergency services in Brazil is not facilitating access to the population due to geographical barriers associated with great distances.
Authors: Pedro Vasconcelos Amaral; Thiago Augusto Hernandes Rocha; Allan Claudius Queiroz Barbosa; Adriana Lein; João Ricardo Nickenig Vissoci Journal: Int J Equity Health Date: 2017-12-04
Authors: Lincoln Luís Silva; Amanda de Carvalho Dutra; Luciano de Andrade; Pedro Henrique Iora; Guilherme Luiz Rodrigues Ramajo; Iago Amado Peres Gualda; João Felipe Hermann Costa Scheidt; Pedro Vasconcelos Maia do Amaral; Thiago Augusto Hernandes Rocha; Catherine Ann Staton; João Ricardo Nickenig Vissoci; Rosilene Fressatti Cardoso Journal: Front Public Health Date: 2021-11-16
Authors: Hari S Iyer; John Flanigan; Nicholas G Wolf; Lee Frederick Schroeder; Susan Horton; Marcia C Castro; Timothy R Rebbeck Journal: BMJ Glob Health Date: 2020-10
Authors: Thiago Augusto Hernandes Rocha; Joao Vissoci; Nubia Rocha; Dan Poenaru; Mark Shrime; Emily R Smith; Henry E Rice Journal: BMJ Open Date: 2020-03-24 Impact factor: 2.692