Rocha T A H, da Silva N C, Amaral P V, Barbosa A C Q, Rocha J V M, Alvares V, de Almeida D G, Thumé E, Thomaz E B A F, de Sousa Queiroz R C, de Souza M R, Lein A, Toomey N, Staton C A, Vissoci J R N, Facchini L A
Federal University of Minas Gerais, School of Economics, Center of Post-graduate and Research in Administration Belo Horizonte, Minas Gerais, Brazil.
Federal University of Minas Gerais, Faculty of Economics, Observatory of Human Resources in Health, Belo Horizonte, Minas Gerais, Brazil.
Public Health. 2017 Dec;153:9-15. doi: 10.1016/j.puhe.2017.07.013. Epub 2017 Aug 11.
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).
Cross-sectional ecological study.
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.
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.
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.
健康地理学研究对于应急卫生服务的规划和分配至关重要。卫生设施的地理分布是及时、高质量获得应急服务的重要因素；因此，本研究分析了巴西的应急卫生保健网络，重点分析了小型医院（SHs）的作用。
横断面生态学研究。
收集了9429家医院的数据，其中3524家为小型医院，5905家为高复杂性中心（HCCs）。为了进行分析，在考察应急护理能力的替代指标时，我们考虑了四个专科：成人、儿科、新生儿和产科。我们分析了医院的空间分布，确定了完全依赖小型医院的市以及这些城市与高复杂性中心的距离。
分别有超过1400万和3000万人距离设有成人重症监护病房（ICU）和儿科ICU的高复杂性中心至少120公里。就新生儿护理分布而言，12%的人口距离设有新生儿ICU的卫生设施超过120公里。产科情况与其他专科不同，巴西81%的总人口距离此类卫生设施在1小时或更短时间内。
我们的结果突出了巴西卫生保健设施分布的两极分化。医院集中在较发达的城市地区，农村地区和亚马逊地区存在获取差距。我们的结果表明，由于与远距离相关的地理障碍，巴西应急服务的分布不利于民众获得服务。
