Uchimura Liza Yurie Teruya, Viana Ana Luiza D Ávila, Marchildon Gregory P
1 Department of Preventive Medicine, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
2 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Healthc Manage Forum. 2019 May;32(3):163-166. doi: 10.1177/0840470418817913. Epub 2019 Apr 4.
The aim of this paper is to examine the approach taken to regionalization in Ontario, Canada, and its impact on health system performance as perceived by managers and clinicians. This is a qualitative study, with thematic analysis, based on interviews with 23 managers and clinicians working in primary healthcare and emergency care in two regions of Ontario. Our findings demonstrate that both sets of actors see regional structures as contributing significantly to improving their respective health system although they also identify areas that require improvement. Managers and clinicians agreed on propositions to focus on health determinants, major considerations specific to the local context (population, geography) and support for a three-level system with well-defined functions. However, they also expressed differing propositions about the political power of hospitals.
本文旨在探讨加拿大安大略省的区域化举措，以及管理者和临床医生所认为的该举措对卫生系统绩效的影响。这是一项定性研究，采用主题分析法，基于对安大略省两个地区从事初级医疗保健和急诊护理工作的23名管理者和临床医生的访谈。我们的研究结果表明，尽管两组参与者都指出了需要改进的领域，但他们都认为区域结构对改善各自的卫生系统有显著贡献。管理者和临床医生在一些主张上达成了一致，包括关注健康决定因素、针对当地情况（人口、地理）的主要考量因素，以及支持具有明确职能的三级体系。然而，他们在医院的政治权力方面也表达了不同的主张。
