Significant changes have taken place in the ambulance medical service field in the recent period. Legal entity of public law “112”, which provides timely call transfer to appropriate medical crew has been established under the Ministry of Internal Affairs. Procurement of specially equipped new vehicles has been carried out across Tbilisi. Compared to the previous years, equipping of medical crews and quality of provided service has been significantly improved. Program implementation and financing system has changed in the regions of Georgia.
State Audit Office of Georgia has inquired changes that have taken place in the ambulance medical service field. Issues of Economy, Efficiency and Effectiveness of ambulance medical service system has been studied and corresponding recommendations have been issued. Audit spanned 2010-2012 and the first half of 2013.
Significant Audit Findings:
- Medical priority defining system is not developed across the country. Response times are not defined for high, medium and low priority calls. For 4% of total number of calls (280 thousand) medical crews need more than 1 hour to reach the destination. During the last 9 months, there have been approximately 3,000 cases when crews need from 2 to 10 hours.
- There are no emergency medical protocols; qualification of doctors and required training programs are not standardized, the level of proficiency of doctors is significantly different in Tbilisi and regions.
- The program implementer in Tbilisi has not ensured economic spending of resources: in 2013, the City Hall of Tbilisi has purchased 80 specially equipped high performance vehicles. The cost was 3.6 million GEL. According to international practice, using these vehicles is only necessary when a patient is in critical condition and needs to be hospitalized. Considering types of incidents, shares of these types of incidents in the total number of calls and low rates of hospitalization, out of 80 vehicles, at least 35 could have been ordinary vehicles (passenger cars), which would enable to save approximately 953.9 thousand GEL. Moreover, approximately 228.5 thousand GEL would be saved annually on fuel, and after expiration of warranty service, costs of care-keeping.
- The Ministry and LEPL “112” do not have appropriate instruments to ensure the quality of the service and timely response in the regions. Distribution of medical crews in the regions is not optimal. Regional settings does not ensure optimal distance responses to the emergency calls. The majority of the vehicles have technical problems, which causes late or no arrival of the medical crews at the destination, which means that vehicles from nearby municipalities have to respond to these calls. During August 2013, for 2 days, 75 calls were not responded to, due to the technical problems of the auto park of Zugdidi. Along with the technical problems, the Ministry has lost control of situation in regions after letting insurance companies implement the program. GPS system is not functioning in regions, nor are means of alternative communications, therefore LEPL “112” has difficulties when communicating with the regions, both when transmitting messages and monitoring the performance.
Recommendations
To the Ministry of Labor, Health and Social Affairs of Georgia; LEPL 112; Tbilisi City Hall and LTD “Emergency Medical Center”:
- Emergency medical service model should be developed in the long run and provided services should be improved. The Ministry should ensure that accredited program protocols/guidelines are standardized across the country in line with international standards and best practices.
- Program implementer and service provider should use financial resources according to strategic plan, priorities, correct planning of the activities and analysis, considering the principle of economy, which ensures high quality of services.
- Relevant system should be created and quality assurance mechanisms should be implemented according to the priorities. Late responses to the call initiations and cases when the medical crew does not arrive on the destination.
- To decrease the number of unnecessary calls, alternative emergency medical care services, such as telephone consultancy (hear and treat) should be employed. Program implementers should raise society’s awareness with joint forces, using educational and informative instruments. The Ministry should use all available means to increase the role of primary healthcare, which will decrease unnecessary calls.
- The Ministry should ensure optimal allocation of the medical crews across the municipalities considering size of population and geographic locations as well as demand for emergency medical care and other significant factors. To achieve timely response, the Ministry should ensure that response will be made from optimal distance. Emergency medical service strategic development plan should be developed considering the principles of economy and efficiency.
- Financing rule of “Emergency Medical Care Program” should be reconsidered. For the individuals that have individual or corporate insurance, emergency medical services that are provided after calling 112 are financed by the state budget. Co-financing of emergency medical services by the insurance companies would contribute to significant budgetary cost-savings, since the number of insured people is increasing over years.
