Brown Sally, Castelli Michele, Hunter David J, Erskine Jonathan, Vedsted Peter, Foot Catherine, Rubin Greg
School of Medicine, Pharmacy and Health, Durham University Queen's Campus, Wolfson Research Institute, Thornaby on Tees TS 17 6BH, UK.
School of Medicine, Pharmacy and Health, Durham University Queen's Campus, Wolfson Research Institute, Thornaby on Tees TS 17 6BH, UK.
Soc Sci Med. 2014 Sep;116(100):56-63. doi: 10.1016/j.socscimed.2014.06.030. Epub 2014 Jun 24.
Striking differences exist in outcomes for cancer between developed countries with comparable healthcare systems. We compare the healthcare systems of 3 countries (Denmark, Norway, Sweden), 3 UK jurisdictions (England, Wales and Northern Ireland), 3 Canadian provinces (British Columbia, Manitoba, Ontario) and 2 Australian states (New South Wales, Victoria) using a framework which assesses the possible contribution of primary care systems to a range of health outcomes, drawing on key characteristics influencing population health. For many of the characteristics we investigated there are no significant differences between those countries with poorer cancer outcomes (England and Denmark) and the rest. In particular, regulation, financing, the existence of patient lists, the GP gatekeeping role, direct access to secondary care, the degree of comprehensiveness of primary care services, the level of cost sharing and the type of primary care providers within healthcare systems were not specifically and consistently associated with differences between countries. Factors that could have an influence on patient and professional behaviour, and consequently contribute to delays in cancer diagnosis and poorer cancer outcomes in some countries, include centralisation of services, free movement of patients between primary care providers, access to secondary care, and the existence of patient list systems. It was not possible to establish a causal correlation between healthcare system characteristics and cancer outcomes. Further studies should explore in greater depth the associations between single health system factors and cancer outcomes, recognising that in complex systems where context is all-important, it will be difficult to establish causal relationships. Better understanding of the interaction between healthcare system variables and patient and professional behaviour may generate new hypotheses for further research.
在医疗体系相当的发达国家中，癌症治疗结果存在显著差异。我们使用一个框架，评估初级保健系统对一系列健康结果的可能贡献，并借鉴影响人群健康的关键特征，对3个国家（丹麦、挪威、瑞典）、英国3个司法管辖区（英格兰、威尔士和北爱尔兰）、加拿大3个省份（不列颠哥伦比亚、马尼托巴、安大略）以及澳大利亚2个州（新南威尔士、维多利亚）的医疗体系进行比较。对于我们所调查的许多特征而言，癌症治疗结果较差的国家（英格兰和丹麦）与其他国家之间没有显著差异。特别是，医疗体系中的监管、融资、患者名单的存在、全科医生的把关作用、直接获得二级医疗服务的机会、初级保健服务的综合程度、费用分担水平以及初级保健提供者的类型，并没有与各国之间的差异形成特定且一致的关联。可能影响患者和专业人员行为，进而导致某些国家癌症诊断延迟和癌症治疗结果较差的因素包括服务集中化、患者在初级保健提供者之间的自由流动、获得二级医疗服务的机会以及患者名单系统的存在。无法在医疗体系特征与癌症治疗结果之间建立因果关系。进一步的研究应更深入地探讨单一卫生系统因素与癌症治疗结果之间的关联，同时认识到在背景至关重要的复杂系统中，很难建立因果关系。更好地理解医疗体系变量与患者和专业人员行为之间的相互作用，可能会为进一步研究产生新的假设。
