Category 4 emergency care at the primary health care level: A population-based approach to resource optimisation

The aim of the study was to analyse the impact of the Category 4 call routing reform on the dynamics of structural and operational indicators of the emergency medical service in the Republic of Kazakhstan from 2019 to 2024. The methodological basis was a retrospective population study based on aggregated official state statistics. The calculation of the population load rate (IR) per 1,000 population, the ineffective workload rate (IUR), the workforce transformation index, the basic growth rate assessment method, and a comparative analysis of structural shares were used. The population load rate (IR) demonstrated a V-shaped trajectory: a decrease from 426.2 to 374.6 per 1,000 population in 2020 (-12.1%), followed by a recovery to 416.9 in 2024. An analysis of the call structure revealed that after 2019 (30.2%), Category 4 calls became the dominant type. From 2020 to 2024, such calls consistently led, accounting for over 36% of the total number of service calls. The rate of late arrivals for Category 4 calls among primary care teams was 2.8%, compared to 5.1% among ambulance teams. The ineffective workload rate (IUR) remained in the range of 4.04-4.94% despite the structural restructuring of its components: unjustified calls decreased by 60.3%, while unsuccessful dispatches increased by 55.8%. Physician staffing in 2024 was 75.8%, and the physician shortage reached 471.25 positions (+39.1% compared to 2023). Ambulance vehicle depreciation returned to a critical level of 60.4%. The successful resuscitation rate increased from 38.3% to 53.1% (+14.8 percentage points). The results obtained can be used to improve inter-tier routing of ambulance calls, inform regional management decisions on primary health care infrastructure development, and plan service staffing