Coulter A, McPherson K, Vessey M
Unit of Clinical Epidemiology, University of Oxford, Oxford Regional Health Authority, Headington, England.
Soc Sci Med. 1988;27(9):987-94. doi: 10.1016/0277-9536(88)90289-4.
Hysterectomy is performed much less frequently in Britain than in North America, Australia and some European countries. Various theories have been advanced to explain this lower rate of surgery. These include: fewer health care resources (hospital beds, surgeons); much less fee-for-service medicine; differences in the attitudes of surgeons; differences in health care organisation, in particular the gatekeeping role of general practitioners; and differences in patients' expectations. This paper reviews the evidence on sources of variation and examines the extent to which hysterectomy rates vary between countries, and between small areas and social groups within Britain. Following an examination of national trends, evidence is presented from studies carried out in the Oxford region to illustrate the extent of variation in the rate at which hysterectomy is carried out and to explore the possible reasons for the differences. The article considers the health policy implications of an apparent increase in demand for hysterectomy and argues the case for a thorough evaluation of the impact of this operation on quality of life.
在英国，子宫切除术的实施频率远低于北美、澳大利亚和一些欧洲国家。人们提出了各种理论来解释这种较低的手术率。这些理论包括：医疗保健资源（医院床位、外科医生）较少；按服务收费的医疗模式少得多；外科医生态度的差异；医疗保健组织方面的差异，特别是全科医生的把关作用；以及患者期望的差异。本文回顾了关于差异来源的证据，并研究了子宫切除术在不同国家之间以及英国国内小区域和社会群体之间的差异程度。在考察了全国趋势之后，给出了牛津地区开展的研究证据，以说明子宫切除术实施率的差异程度，并探讨差异产生的可能原因。本文考虑了子宫切除术需求明显增加对健康政策的影响，并主张对该手术对生活质量的影响进行全面评估。
