Yao Caroline A, Swanson Jordan, Chanson Dayana, Taro Trisa B, Gura Barrie, Figueiredo Jane C, Wipfli Heather, Hatcher Kristin, Vanderburg Richard, Magee William P
Los Angeles, Calif.; and Virginia Beach, Va.
From the Division of Plastic and Reconstructive Surgery, the University of Southern California Institute of Global Health, and the Department of Preventive Medicine, Keck School of Medicine of the University of Southern California; the Department of Plastic and Reconstructive Surgery, Shriners Hospital for Children; the Division of Plastic and Reconstructive Surgery, Children Hospital Los Angeles; and Operation Smile International.
Plast Reconstr Surg. 2016 Nov;138(5):887e-895e. doi: 10.1097/PRS.0000000000002656.
Despite health system advances, residents of low- and middle-income countries continue to experience substantial barriers in accessing health care, particularly for specialized care such as plastic and reconstructive surgery.
A cross-sectional household survey of patients seeking surgical care for cleft lip and/or cleft palate was completed at five Operation Smile International mission sites throughout Vietnam (Hanoi, Nghe An, Hue, Ho Chi Minh City, An Giang, and Bac Lieu) in November of 2014.
Four hundred fifty-three households were surveyed. Cost, mistrust of medical providers, and lack of supplies and trained physicians were cited as the most significant barriers to obtaining surgery from local hospitals. There was no significant difference in household income or hospital access between those who had and had not obtained cleft surgery in the past. Fewer households that had obtained cleft surgery in the past were enrolled in health insurance (p < 0.001). Of those households/patients who had surgery previously, 83 percent had their surgery performed by a charity. Forty-three percent of participants did not have access to any other surgical cleft care and 41 percent did not have any other access to nonsurgical cleft care.
The authors highlight barriers specific to surgery in low- and middle-income countries that have not been previously addressed. Patients rely on charitable care outside the centralized health care system; as a result, surgical treatment of cleft lip and palate is delayed beyond the standard optimal window compared with more developed countries. Using these data, the authors developed a more evidence-based framework designed to understand health behaviors and perceptions regarding reconstructive surgical care.
尽管卫生系统有所进步，但低收入和中等收入国家的居民在获得医疗保健方面仍面临重大障碍，尤其是在获得诸如整形和重建手术等专科护理方面。
2014年11月，在越南各地的五个国际微笑行动任务地点（河内、义安、顺化、胡志明市、安江和薄辽），对寻求唇裂和/或腭裂手术治疗的患者进行了一项横断面家庭调查。
共调查了453户家庭。费用、对医疗服务提供者的不信任以及物资和训练有素的医生的缺乏被认为是在当地医院获得手术的最主要障碍。过去接受过唇裂手术和未接受过唇裂手术的家庭在家庭收入或就医机会方面没有显著差异。过去接受过唇裂手术的家庭中，参加医疗保险的较少（p<0.001）。在那些之前接受过手术的家庭/患者中，83%是由慈善机构进行的手术。43%的参与者无法获得任何其他唇裂手术护理，41%的参与者无法获得任何其他唇裂非手术护理。
作者强调了低收入和中等收入国家手术特有的、以前未被解决的障碍。患者依赖集中医疗系统之外的慈善护理；因此，与更发达国家相比，唇腭裂的手术治疗被推迟到标准最佳窗口期之后。利用这些数据，作者制定了一个更基于证据的框架，旨在了解关于重建手术护理的健康行为和观念。
