Health Promotion International, Vol. 9, No. 4, 259-267, 1994
© Oxford University Press 1994
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Inappropriate use of emergency ambulance services and the implications for primary health care in Japan
Department of Public Health and Environmental Science, School of Medicine, Tokyo Medical and Dental University Tokyo, Japan
Address for correspondence: Address for correspondence: Professor Takehito Takano Department of Public Health and Environmental Science School of Medicine Tokyo Medical and Dental University Yushima 1-5-45, Bunkyo-ku, Tokyo 113 Japan
The number and per-capita emergency transports by public ambulances and the percentage of transports of patients with non-emergency conditions has been increasing in Japan, especially in urban areas. Public ambulance services are, of course, essential for transporting patients with crucial health problems. However, inappropriate ambulance use by patients who do not need emergency treatment, but who need primary health care, means that these patients cannot get suitable health care, and diminishes the effectiveness and efficiency of emergency medical-care service systems. The purposes of this study were to identify the factors relating to usage of public ambulance services in urban areas, to determine how to make these services more effective and more efficient, and to discuss how to provide primary health-care services so as to reduce the inappropriate use of public ambulance services. We investigated the accessibility of primary health-care services, the characteristics of public ambulance service utilization, and the potential needs of the elderly for emergency-care services in two Tokyo wards: Edogawa andSetagaya. There were less health resources, such as clinics, hospital beds and physicians, per capita in Edogawa than in Setagaya. Both the percentage of ambulance transports of patients suffering from mild problems and the percentage of ambulance transports on Sundays were higher in Edogawa than in Setagaya. Our survey showed that the percentages of the elderly who would call for ambulances for each of three specific health problems (fever, chest pain and ankle sprain) were all higher in Edogawa than in Setagaya. In both wards, elderly people living with their children and/or grandchildren were more likely to choose different health resources according to the specific problem being experienced than were elderly people living with other aged persons but without young people. The insufficient development of primary healthcare resources and systems increased the inappropriate use of high-cost emergency ambulance services by the elderly living in urban areas, where family support is weakening. Health systems therefore need to be reoriented so as to enhance accessibility to primary healthcare services.
Key words: emergency ambulance service; primary health care; reorienting of health systems
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