Galway K J, Murphy A W, O'Reilly D, O'Dowd T, O'Neill C, Shryane E, Steele K, Bury G, Gilliland A, Kelly A
Centre for Clinical and Population Sciences, Queen's University, Belfast Royal Group of Hospitals, Mulhouse Building, Belfast BT12 6BJ.
Ir Med J. 2007 Jun;100(6):494-7.
Timely and convenient access to primary healthcare is essential for the health of the population as delays can incur additional health and financial costs. Access to health care is under increasing scrutiny as part of the drive to contain escalating costs, while attempting to maintain equity in service provision. The objective was to compare primary care services in Republic of Ireland and Northern Ireland, and to report on perceived and reported access to GP services in universal access and mixed private/public systems. A questionnaire study was performed in Northern Ireland (NI) and the Republic of Ireland (ROI). Patients of 20 practices in the ROI and NI were contacted (n = 22,796). Main outcome measures were overall satisfaction and the access to GP services. Individual responses and scale scores were derived using the General Practice Assessment Questionnaire (G-PAQ). The response rate was 52% (n = 11,870). Overall satisfaction with GP practices was higher in ROI than in NI (84.2% and 80.9% respectively). Access scores were higher in ROI than in NI (69.2% and 57.0% respectively) Less than 1 in 10 patients in ROI waited two or more working days to see a doctor of choice (8.1%) compared to almost half (45.0%) in NI. In NI overall satisfaction decreased as practice size increased; 82.8%, 80.4%, and 75.8%. In both systems, in large practices, accessibility is reduced when compared to smaller practices. The faster access to GP services in ROI may be due to the deterrent effect of the consultation charge freeing up services although, as it is the poorest and sickest who are deterred by the charge this improved accessibility may come at a significant cost in terms of equity. The underlying concern for policy makers centres around provision of equitable services.
及时便捷地获得初级医疗保健服务对于民众健康至关重要，因为延误可能会带来额外的健康和经济成本。作为控制不断攀升的成本的一部分，同时试图在服务提供方面保持公平性，医疗保健的可及性正受到越来越多的审视。目的是比较爱尔兰共和国和北爱尔兰的初级医疗服务，并报告在全民医保和公私混合体系中对全科医生服务的感知可及性和报告可及性。在北爱尔兰（NI）和爱尔兰共和国（ROI）进行了一项问卷调查研究。联系了ROI和NI的20家医疗机构的患者（n = 22,796）。主要结局指标是总体满意度和获得全科医生服务的情况。使用全科医疗评估问卷（G-PAQ）得出个体反应和量表分数。回复率为52%（n = 11,870）。ROI对全科医疗服务的总体满意度高于NI（分别为84.2%和80.9%）。ROI的可及性得分高于NI（分别为69.2%和57.0%）。在ROI，不到十分之一的患者（8.1%）等待两个或更多工作日才能见到首选医生，而在NI这一比例接近一半（45.0%）。在NI，总体满意度随着医疗机构规模的增大而降低；分别为82.8%、80.4%和75.8%。在这两个体系中，与小型医疗机构相比，大型医疗机构的可及性降低。ROI更快获得全科医生服务可能是由于诊疗收费的威慑作用使服务得以释放，尽管由于最贫困和患病最重的人群因收费而受到阻碍，这种改善的可及性可能在公平性方面付出巨大代价。政策制定者的根本担忧集中在公平服务的提供上。
