Al-Jazaeri Ayman, Alshwairikh Lama, Aljebreen Manar A, AlSwaidan Nourah, Al-Obaidan Tarfah, Alzahem Abdulrahman
Dr. Ayman Al-Jazaeri, Division of Pediatrc Surgery,, Department of Surgery,, King Saud University,, Riyadh 1355, Saudi Arabia,
Ann Saudi Med. 2017 Jul-Aug;37(4):290-296. doi: 10.5144/0256-4947.2017.290.
Faced with growing healthcare demand, the Saudi government is increasingly relying on privatization as a tool to improve patient access to care. Variation in children's access to surgical care between public (PB) and private providers (PV) has not been previously analyzed.
To compare access to pediatric surgical services between two coexisting PB and PV.
Retrospective comparative study.
A major teaching hospital and the largest PV group in Saudi Arabia.
The outcomes for children who underwent inguinal herniotomy (IH) between May 2010 and December 2014 at both providers were with IH serving as the model. Data collected included patient demographics, insurance coverage, referral pattern and access parameters including time-to-surgery (TTS), surgery wait time (SWT) and duration of symptoms (DOS).
MAIN OUTCOME MEASURE(S): TTS, SWT and DOS.
Of 574 IH cases, 56 cases of in-hospital referrals were excluded leaving 290 PB and 228 PV cases. PV patients were younger (12.0 vs 16.4 months, P=.043) and more likely to be male (81.6% vs 72.8%, P=.019), expatriates (18% vs 3.4%, P < .001) and insured (47.4% vs 0%, P < .001). The emergency department was more frequently the source for PB referrals (35.2% vs 12.7%, P < .001) while most PV patients were self-referred (72.8% vs 16.7%, P < .001). Access parameters were remarkably better at PV: TTS (21 vs 66 days, P < .001), SWT (4 vs 31 days, P < .001) and DOS (33 vs 114 days, P < .001).
When coexisting, PV offers significantly better access to pediatric surgical services compared to PB. Diverting public funds to expand children's access to PV can be a valid choice to improve access to care in case when outcomes with the two providers are similar.
Although it is the first and largest comparison in the pediatric population, the sample may not represent the whole population since it is confined to a single selected surgical condition.
面对不断增长的医疗保健需求，沙特政府越来越依赖私有化作为改善患者就医机会的工具。此前尚未分析过公立（PB）和私立医疗机构（PV）在儿童获得外科护理方面的差异。
比较同时存在的公立和私立医疗机构在儿科手术服务方面的可及性。
回顾性比较研究。
沙特阿拉伯的一家主要教学医院和最大的私立医疗机构集团。
以2010年5月至2014年12月期间在两家机构接受腹股沟疝修补术（IH）的儿童为研究对象，将IH作为模型。收集的数据包括患者人口统计学信息、保险覆盖情况、转诊模式以及包括手术时间（TTS）、手术等待时间（SWT）和症状持续时间（DOS）在内的可及性参数。
TTS、SWT和DOS。
在574例IH病例中，排除了56例院内转诊病例，剩余290例公立病例和228例私立病例。私立机构的患者更年幼（12.0个月对16.4个月，P = 0.043），更可能为男性（81.6%对72.8%，P = 0.019）、外籍人士（18%对3.4%，P < 0.001）且有保险（47.4%对0%，P < 0.001）。公立机构的转诊来源更常为急诊科（35.2%对12.7%，P < 0.001），而大多数私立机构患者是自我转诊（72.8%对16.7%，P < 0.001）。私立机构的可及性参数明显更好：TTS（21天对66天，P < 0.001）、SWT（4天对31天，P < 0.001）和DOS（33天对114天，P < 0.001）。
当公立和私立机构同时存在时，与公立机构相比，私立机构在儿科手术服务方面提供了显著更好的可及性。在两家机构治疗效果相似的情况下，将公共资金用于扩大儿童获得私立机构服务的机会可能是改善就医可及性的有效选择。
尽管这是儿科人群中首次且规模最大的比较，但样本可能不代表全部人群，因为它仅限于单一选定的外科疾病。
