Friedman Steven Marc, Schofield Lee, Tirkos Sam
Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Eur J Emerg Med. 2007 Oct;14(5):260-4. doi: 10.1097/MEJ.0b013e32825f54a4.
The Canada Health Act legislates that Canadian citizens have access to healthcare that is publicly administered, universal, comprehensive, portable, and accessible (i.e. unimpeded by financial, clinical, or social factors). We surveyed public impressions and practices regarding preferential access to healthcare and queue jumping.
Households were randomly selected from the Toronto telephone directory. English speakers aged 18 years or older were solicited for a standardized telephone survey. Statistical analysis was performed using SPSS and SAS.
Fifteen percent (n=101) of 668 solicited were surveyed. Ninety-five percent advocated equal access based on need. Support for queue jumping in the emergency department (ED) was strong for cases of emergency, severe pain, and pediatrics, equivocal for police, and minimal for the homeless, doctors, hospital administrators, and government officials. To improve a position on a waiting list, approximately half surveyed would call a friend who is a doctor, works for a doctor, or is a hospital administrator. Sixteen percent reported having done this. The likelihoods of offering material inducement for preferential access were 30 and 51% for low and high-impact medical scenarios, respectively. The likelihoods of offering nonmaterial inducement were 56 and 71%, respectively. Responses were not associated with sex, occupation, or education.
Respondents expressed support for equal access based on need. Policy and scenario-type questions elicited different responses. Expressed beliefs may vary from personal practice. Clearly defined and enforced policies at the hospital and provincial level might enhance principles of fairness in the ED queue.
《加拿大健康法案》规定，加拿大公民有权获得由公共管理、具有普遍性、全面性、可携带性且可及（即不受经济、临床或社会因素阻碍）的医疗保健服务。我们调查了公众对优先获得医疗保健服务和插队现象的看法及做法。
从多伦多电话簿中随机抽取家庭。邀请18岁及以上的讲英语者参与标准化电话调查。使用SPSS和SAS进行统计分析。
在668名被邀请者中，有15%（n = 101）接受了调查。95%的人主张根据需求平等获得医疗服务。对于急诊、剧痛和儿科病例，在急诊科插队的支持率较高；对于警察，支持率不明确；对于无家可归者、医生、医院管理人员和政府官员，支持率极低。为了在等候名单上提升位次，约一半的被调查者会打电话给身为医生、为医生工作或担任医院管理人员的朋友。16%的人报告称这样做过。在低影响和高影响医疗场景中，为优先获得服务提供物质诱因的可能性分别为30%和51%。提供非物质诱因的可能性分别为56%和71%。回答与性别、职业或教育程度无关。
受访者表示支持根据需求平等获得医疗服务。政策和场景类型问题引发了不同的回答。表达的信念可能与个人行为不同。在医院和省级层面明确界定并执行政策，可能会增强急诊科排队的公平原则。
