Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, M5T 3M6, Canada.
Int J Equity Health. 2023 Jul 13;22(1):133. doi: 10.1186/s12939-023-01872-z.
Ensuring healthcare systems provide equitable, high quality care is critical to their users' overall health and wellbeing. Typically, systems use various performance frameworks and related indicators to monitor and improve healthcare. Although these frameworks usually include equity, the extent that equity is reflected in these measurements remains unclear. In order to create a system that meets patients' needs, addressing this uncertainty is important. This paper presents findings from a scoping review that sought to answer the question 'How is equity conceptualized in healthcare systems when assessing healthcare system performance?'.
Levac's scoping review approach was used to locate relevant articles and create a protocol. Included, peer-reviewed articles were published between 2015 to 2020, written in English and did not discuss oral health and clinician training. These healthcare areas were excluded as they represent large, specialized bodies of literature beyond the scope of this review. Online databases (e.g., MEDLINE, CINAHL Plus) were used to locate articles.
Eight thousand six hundred fifty-five potentially relevant articles were identified. Fifty-four were selected for full review. The review yielded 16 relevant articles. Six articles emanated from North America, six from Europe and one each from Africa, Australia, China and India respectively. Most articles used quantitative methods and examined various aspects of healthcare. Studies centered on: indicators; equity policies; evaluating the equitability of healthcare systems; creating and/or testing equity tools; and using patients' sociodemographic characteristics to examine healthcare system performance.
Although equity is framed as an important component of most healthcare systems' performance frameworks, the scarcity of relevant articles indicate otherwise. This scarcity may point to challenges systems face when moving from conceptualizing to measuring equity. Additionally, it may indicate the limited attention systems place on effectively incorporating equity into performance frameworks. The disjointed and varied approaches to conceptualizing equity noted in relevant articles make it difficult to conduct comparative analyses of these frameworks. Further, these frameworks' strong focus on users' social determinants of health does not offer a robust view of performance. More work is needed to shift these narrow views of equity towards frameworks that analyze healthcare systems and not their users.
确保医疗保健系统提供公平、高质量的护理对于用户的整体健康和福祉至关重要。通常，系统使用各种绩效框架和相关指标来监测和改善医疗保健。尽管这些框架通常包括公平性，但公平性在这些衡量标准中的体现程度尚不清楚。为了创建一个满足患者需求的系统，解决这一不确定性很重要。本文介绍了一项范围综述的结果，该综述旨在回答“在评估医疗保健系统绩效时，医疗保健系统如何概念化公平性？”这个问题。
采用 Levac 的范围综述方法来定位相关文章并制定方案。纳入的同行评议文章发表于 2015 年至 2020 年期间，用英文撰写，不讨论口腔健康和临床医生培训。之所以排除这些医疗保健领域，是因为它们代表了超出本综述范围的大型、专门文献。使用在线数据库（例如，MEDLINE、CINAHL Plus）来定位文章。
确定了 8655 篇潜在相关文章。54 篇文章被选为全文审查。综述产生了 16 篇相关文章。其中 6 篇文章来自北美，6 篇来自欧洲，1 篇分别来自非洲、澳大利亚、中国和印度。大多数文章使用了定量方法，并研究了医疗保健的各个方面。研究集中在：指标；公平政策；评估医疗保健系统的公平性；创建和/或测试公平工具；以及使用患者的社会人口特征来检查医疗保健系统的绩效。
尽管公平被框架为大多数医疗保健系统绩效框架的重要组成部分，但相关文章的稀缺性表明并非如此。这种稀缺性可能表明系统在从概念化到衡量公平性方面面临挑战。此外，这可能表明系统在将公平有效地纳入绩效框架方面投入有限。相关文章中注意到的公平概念化方法的分散和多样化使得对这些框架进行比较分析变得困难。此外，这些框架对用户健康的社会决定因素的强烈关注并没有提供对绩效的全面看法。需要做更多的工作来将这些狭隘的公平观点转变为分析医疗保健系统而不是其用户的框架。
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