Carmel S, Halevy J
Dept. of the Sociology of Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba.
Harefuah. 1999 Nov 1;137(9):363-70, 431.
"Sharap" is a private medical service integrated within our public clinic and hospital services. Clients may choose their physician by paying a fee in addition to what their health insurance agency (Kupat Holim) pays for. All other hospital services are supplied to all patients alike. The main purpose of this study was to evaluate the extent to which this declared policy is maintained in practice. During 5 months in 1997, 198 Sharap patients and 198 regular patients were interviewed in the the general surgery, cardiac surgery, ENT, cardiology, newborn and gynecology wards of this hospital. Both groups were similar in regard to cause of hospitalization, gender, age group (10-year age ranges), and length of hospitalization (at least 24 hours). Similar levels of satisfaction with hospitalization in general and with the nursing service and with supportive services were found in both groups. However, Sharap patients were more satisfied with their physicians than regular patients (87% vs 74%, respectively). Similar results were also found using indirect measures of satisfaction. About 86% in both groups reported having achieved the goal of improvement in health. A high proportion of respondents from both groups (82% and 88%, respectively) could not distinguish between Sharap and regular patients in the ward. However, a greater proportion of regular patients (35% vs 21%) wanted more extensive explanations from their physicians regarding their treatment. Sharap patients belonged to higher socio-economic classes than regular patients. Our evaluation indicates that although the Sharap service enables the affluent to choose their preferred physician, resulting in a different doctor-patient relationship, the service does not create a significant feeling of discrimination among hospitalized patients, and does not interfere with the high level of health services available to the public at large.
“Sharap”是一项整合在我们公共诊所和医院服务中的私人医疗服务。客户除了支付其健康保险机构（库帕特·霍利姆）所支付的费用外，还需额外付费来选择他们的医生。所有其他医院服务则平等地提供给所有患者。本研究的主要目的是评估这一宣称的政策在实际中得到维持的程度。1997年的5个月期间，在该医院的普通外科、心脏外科、耳鼻喉科、心脏病科、新生儿科和妇科病房，对198名Sharap患者和198名普通患者进行了访谈。两组在住院原因、性别、年龄组（10年年龄范围）和住院时间（至少24小时）方面相似。两组在总体住院满意度、护理服务满意度和支持性服务满意度方面水平相似。然而，Sharap患者对其医生的满意度高于普通患者（分别为87%和74%）。使用间接满意度衡量方法也发现了类似结果。两组中约86%的人报告称实现了健康改善的目标。两组中很大比例的受访者（分别为82%和88%）在病房中无法区分Sharap患者和普通患者。然而，更大比例的普通患者（35%对21%）希望医生对其治疗给予更详尽的解释。Sharap患者所属的社会经济阶层高于普通患者。我们的评估表明，尽管Sharap服务使富裕人群能够选择他们心仪的医生，从而导致一种不同的医患关系，但该服务并未在住院患者中造成显著的歧视感，也未干扰广大公众可获得的高水平医疗服务。
