Why not adapt hospital emergency departments to social demands instead of health needs?

Moreno Millán E

During recent years developed countries have witnessed a stepwise increase in the use

of the hospital emergency departments (HED) even in low complexity situations that

could have been managed in other healthcare levels. Apart from being a consequence

of demographic changes (migration and ageing population) other factors may be associated

with this situation such as the perceived need for immediate care, the difficulty

of access to other resources of the system, the lack of public coverage and the socioeconomic

and cultural level. This phenomenon contributes to HED overcrowding, loss of

care continuity and quality, professionals dissatisfaction, delays in the attention of true

emergency situations, higher health costs and has very important consequences on the

management of the rest of the hospital. The interventions made to date to dissuade or

to avoid the increase on the frequentation in HED (education improvements, reducing

administrative barriers, copayment, implementation of primary care centres) have

shown poor effectiveness or even uselessness. Considering the knowledge of the differences

between the need, demand and supply of health care, from an anthropological

and social point of view – and the attempts for justify citizen perceptions in an emergency

– a new functional design should be implemented to manage these processes

in a new scenario, in which the hospital should be adapted to the model of management

of the HED and not vice versa.

Moreno Millán E