Assessing the impact of environmental factors on emergency healthcare quality: Implications for budget allocation

Evaluating the quality of emergency departments in hospitals is crucial for optimizing healthcare and allocating resources effectively. Existing metrics predominantly focus on internal variables (e.g., bed occupancy or time to treatment), neglecting external environmental factors, beyond their control. In response, the contributions of this paper are fourfold. First, we introduce a novel Quality Composite Indicator (QCI) for benchmarking emergency departments quality, considering the specific impact of demographic, socio-economic, patientspecific, and behavioral factors. This metric minimizes the influence of outliers, facilitating a comparison among emergency departments and enabling the identification of top performers based on quality indicators. Second, our study, conducted across 85 health trusts, reveals that emergency departments with higher population density, migration, average income, and deprived households tend to exhibit lower service quality. Moreover, critical patient conditions upon arrival and higher attendance rates exert additional negative influences, while higher obesity rates show a positive correlation with the quality of urgent healthcare services. Third, our analysis highlights differences in how environmental factors (e.g., age, education, or unemployment) affect overall hospital performance versus specialized units like emergency departments. These results suggest that the factors influencing emergency department performance may differ from those affecting broader healthcare institutions. Fourth, we examined the distribution of health budget funds and uncovered significant regional disparities in healthcare quality, contradicting the goal of nationwide uniformity. Furthermore, our study highlights the integration of emergency care funding with general hospital resources in the allocation model, despite being impacted differently by external factors.