Planning for equitable emergency health care : Assessing the geography of ambulance supply and demand in Sweden

Abstract: Providing high-quality health care to everyone who needs it is a central objective for theSwedish health care system. One way in which this goal is broadly pursued is by allocatingresources that maximize the geographical coverage of ambulances, aiming at reducingambulance response times as much as possible, for as many as possible. However, in reality,emergencies tend to be concentrated in space and time. They are more likely to occur atparticular places and times, following people’s routine activities. Likewise, some groups aremore likely to require acute health care, implying that supply needs to be tailored to patientdemand. This thesis investigates the nature of emergency health care (EHC) services byassessing the temporal and the geographical distribution of ambulance services from a supplyand demand perspective using southern Sweden as a study area. Geographical informationsystem (GIS), spatial analysis and regression models underpin the methodology of the study.Findings indicate that there currently exist disparities in access to EHC services in Sweden,both between urban and rural areas and between sociodemographic groups. Depending on howaccessibility is measured, different spatial patterns emerge, suggesting that the current practiceof measuring response times should be complemented by alternative measures of accessibilityin an attempt to reduce inequities in access to ambulances between groups and places. Resultsalso indicate that the demand for EHC services varies both spatially and temporally, and thatdemographic and land use differences can be helpful in explaining such variations. The thesishighlights that currently employed EHC policy goals may entail unexpected inequities in theaccess to and supply of ambulances and, consequently, of EHC. As such, the study opens upfor a discussion on how useful quantitative measures can be in revealing group inequities inaccess to EHC.