LAUSR

Romania faces significant disparities in access to emergency healthcare. This study employs a national geospatial analysis and network-based GIS modelling to assess current spatial accessibility to emergency care services and to develop a scenario-based spatial model for Romania, aiming to improve access to these services. This study is the first to design such a scenario and to do so at a national level. To improve access to the emergency network, this study proposes establishing additional emergency units at designated hospitals. Integrating national-scale data into the Network Analyst tools, we identify critical gaps in emergency service coverage, with current estimates indicating that approximately 65% of the rural population lives in areas with limited or no access to emergency care. Travel time to the nearest emergency care unit exceeds 120 min in remote rural regions, highlighting a severe spatial inequity in healthcare provision. The results show that in our scenario, the total proportion of the population that has to travel for more than 30 min to the nearest emergency care unit has dropped from almost 60.28% to 35.63% when travelling in a private car, and from 72.58% to 46.08% when travelling in an ambulance. In fact, the total number of inhabitants reaching an emergency facility within 30 min increases by more than 4.7 million when travelling by private car and by more than 5 million when travelling by ambulance. These findings underscore the importance of spatial planning in the development of healthcare infrastructure and provide quantitative, spatially explicit evidence to support infrastructure planning and policy decisions aimed at reducing the urban–rural healthcare divide. This study contributes to the broader discourse on spatial justice and health equity, offering local or national authorities a basis for developing improved healthcare policies to improve coverage and reduce the urban–rural healthcare divide.