Center for Health Equity in Surgery and Anesthesia, University of California, San Francisco, USA.
Department of Anesthesia & Periopative Care, University of California, San Francisco, USA.
BMC Health Serv Res. 2022 Apr 29;22(1):579. doi: 10.1186/s12913-022-07976-6.
One aim of publicly-funded health care systems is to provide equitable access to care irrespective of ability to pay. At the same time, differences in socioeconomic status (SES) are associated with health outcomes and access to care, including waiting times for surgery. In public systems where both high- and low-SES patients use the same resources, low-SES patients may be adversely impacted in surgical waiting times. The purpose of this study was to determine whether a publicly-funded health system can provide equitable access to surgical care across socioeconomic status.
Patient-level records were obtained from a comprehensive provincially-administered surgical wait time database, encompassing years 2006-2015 and 98% of Ontario hospitals. Patient SES was determined by linking postal code with the Material and Social Deprivation Index. Surgical waiting times (time in days between decision to treat and surgery) accounted for patient-initiated delays in treatment, and regression analysis considered age, SES, rurality, sex, priority level for surgical urgency (assigned by surgeons), surgical subspecialty, number of visits, and procedure year.
For the 4,253,305 surgical episodes, the mean wait time was 62.3 (SD 75.4) days. Repeated measures least squares regression analysis showed the least deprived SES quintile waited 3 days longer than the most deprived quintile. Wait times dropped in the initial study period but then increased. The proportion of procedures exceeding wait time access targets remained low at 11-13%.
The least deprived SES quintile waited the longest, although the absolute difference was small. This study demonstrates that publicly-funded healthcare systems can provide equitable access to surgical care across SES.
公共资助的医疗保健系统的一个目标是提供公平的医疗服务，无论支付能力如何。与此同时，社会经济地位（SES）的差异与健康结果和医疗服务的获取有关，包括手术等待时间。在高 SES 和低 SES 患者都使用相同资源的公共系统中，低 SES 患者的手术等待时间可能会受到不利影响。本研究的目的是确定公共资助的医疗系统是否可以在社会经济地位方面提供公平的手术服务。
从一个全面的省级手术等待时间数据库中获取患者级记录，该数据库涵盖了 2006 年至 2015 年的时间，覆盖了安大略省 98%的医院。通过将邮政编码与物质和社会剥夺指数相联系来确定患者 SES。手术等待时间（从决定治疗到手术的天数）考虑了患者治疗的延迟，回归分析考虑了年龄、SES、农村、性别、手术紧急程度的优先级（由外科医生分配）、手术专科、就诊次数和手术年份。
在 4253305 例手术中，平均等待时间为 62.3（SD 75.4）天。重复测量最小二乘回归分析显示，最不贫困的 SES 五分位数比最贫困的五分位数等待时间长 3 天。在最初的研究期间，等待时间下降，但随后又增加。超过等待时间访问目标的手术比例仍然很低，为 11-13%。
最不贫困的 SES 五分位数等待时间最长，尽管绝对差异很小。本研究表明，公共资助的医疗保健系统可以在 SES 方面提供公平的手术服务。
