Where are the people in emergency service planning? : Assessing the geography and equity of access to emergency services in Sweden

Sammanfattning: Providing high-quality health care to everyone who needs it is a central objective of the Swedish healthcare system. One way in which this goal is broadly pursued is by allocating resources that maximize the geographical coverage of ambulances, aimed at reducing ambulance respons times as much as possible, for as many as possible. However, emergencies tend to be concentrated in space and time and some groups are more likely to require acute health care, implying that supply needs to be tailored to patient demand. This thesis aims to assess spatial and sociodemographic disparities in access to, and demand for, emergency services in Sweden, with a particular focus on emergency health care (EHC) services. It problematizes how supply and demand are measured, and the consequences this may have for the equitability of access to resources and efficient emergency response. Findings indicate that there currently exist spatial and sociodemographic disparities in access to EHC services in Sweden. The risk of requiring an ambulance is shown to be higher for individuals living in rural areas and for older adults in particular. Concomitantly, these groups have particularly poor levels of accessibility. The findings also indicate that the way that demand and accessibility is measured produce different spatial (and temporal) patterns and that commonly employed indicators of performance in policy (population sizes and response times) are shown to be overestimated and underestimated to varying degrees at certain times and in certain places. Such information is important to convey to planners, as inaccurate estimates may entail that planners have poor knowledge on which to base decisions related to resource allocation, which could in turn affect some places and groups negatively. The thesis highlights that currently employed policy goals may inadvertently entail unexpected inequities in terms of varying levels of accessibility to EHC, where resources are not directed towards the places and groups that need them the most. This opens up a discussion of how quantitative measures that underpin planning are always based on certain conceptualizations over other possible conceptualizations. Ultimately, this thesis may contribute to facilitating the planning of more equitable emergency services.