Equitable emergency access: rhetoric or reality?

The present paper is based on an address given at the Australian Financial Review Health Congress in February, 2005. Let's start with the underlying premise that patients have a valid right to fair and just access to emergency care. Fairness and justice are concepts more comfortably placed within legal and sociological settings than within health. They refer to our ability to deliver care without bias or favour. Our college has published a statement asserting patients' right to appropriate access (Patients' Right to Access Emergency Department Care. ACEM Policy Statement P31, March 2004). The other underlying premise in this discussion is that this issue of equity of access actually matters. It may be of significance at a moral level, at a relative resource consumption level, at the level of occupation of system capacity, or at the level of clinical outcomes for individual patients.