McLeod Deborah, Dew Kevin, Morgan Sonya, Dowell Anthony, Cumming Jackie, Cormack Donna, McKinlay Eileen, Love Tom
Department of General Practice, Wellington School of Medicine, University of Otago, PO Box 7343, Wellington South, New Zealand.
J Health Serv Res Policy. 2004 Oct;9 Suppl 2:41-7. doi: 10.1258/1355819042349916.
To explore factors potentially influencing equitable access to elective surgery in New Zealand by describing clinicians' perceptions of equity and the factors they consider when prioritising patients for elective surgery.
A qualitative study in selected New Zealand localities. A purposive sample of 49 general practitioners, specialists and registrars were interviewed. Data were analysed thematically.
General practitioners described unequal opportunities for patients to access primary and secondary care and, in particular, private sector elective surgery. They felt that socio-economically disadvantaged patients were less able to advocate for themselves and were more vulnerable to being lost to the elective surgical booking system as well as being less able to access private care. Both GPs and secondary care clinicians described situations where they would personally advocate for individual patients to improve their access. Advocacy was related to clinicians' perceptions of the 'value' that patients would receive from the surgery and patients' needs for public sector funding.
The structure of the health system contributes to inequities in access to elective care in New Zealand. Subjective decision making by clinicians has the potential to advantage or disadvantage patients through the weighting clinicians place on socio-demographic factors when making rationing decisions. Review of the potential structural barriers to equitable access, further public debate and guidance for clinicians on the relative importance of socio-demographic factors in deciding access to rationed services are required for allocation of services to be fair.
通过描述临床医生对公平性的看法以及他们在为择期手术患者确定优先顺序时考虑的因素，探索可能影响新西兰公平获得择期手术的因素。
在新西兰选定地区进行的一项定性研究。对49名全科医生、专科医生和住院医生进行了目的抽样访谈。对数据进行了主题分析。
全科医生描述了患者在获得初级和二级医疗服务，特别是私营部门择期手术方面机会不平等的情况。他们认为，社会经济地位不利的患者自我维权能力较差，更容易在择期手术预约系统中失去机会，也更难获得私人医疗服务。全科医生和二级医疗临床医生都描述了他们会亲自为个别患者争取权益以改善其就医机会的情况。这种争取权益的行为与临床医生对患者从手术中获得的“价值”的看法以及患者对公共部门资金的需求有关。
卫生系统的结构导致了新西兰在获得择期医疗服务方面的不公平。临床医生的主观决策有可能使患者受益或受损，因为临床医生在做出配给决策时对社会人口因素的权重不同。为了使服务分配公平，需要审查公平获得医疗服务的潜在结构性障碍，进一步开展公众辩论，并为临床医生提供关于社会人口因素在决定获得配给服务方面相对重要性的指导。
