Da. Alter et al., A SURVEY OF PROVIDER EXPERIENCES AND PERCEPTIONS OF PREFERENTIAL ACCESS TO CARDIOVASCULAR CARE IN ONTARIO, CANADA, Annals of internal medicine, 129(7), 1998, pp. 567-572
Background: The public health insurance system in Canada is predicated
on equal access to care for persons in need. Objective: To determine
the views and experiences of Ontario physicians and hospital administr
ators in providing patients with preferential access to specialized ca
rdiovascular care on the basis of nonclinical factors. Design: Survey
with self-administered questionnaire. Setting: Ontario, Canada. Partic
ipants: All Ontario cardiologists (n = 268), cardiac surgeons (n = 68)
, and hospital chief executives (n = 218) and random samples of intern
ists (n = 300) and family physicians (n = 300). Measurements: Elicited
responses (yes or no) to questions on whether and why preferential ac
cess occurred and whether the respondents had been personally involved
in such a situation. Results: After undeliverable surveys and respond
ents no longer involved with acute care were excluded, the eligible re
sponse rate was 71.3% (788 of 1105 respondents). More than 80% of phys
icians and 53% of hospital chief executives had been personally involv
ed in managing a patient who had received preferential access on the b
asis of factors other than medical need. Patients deemed most likely t
o receive such treatment were those with personal ties to the treating
physicians (93% [95% CI, 91% to 95%]), high-profile public figures (8
5% [CI, 82% to 87%]), and politicians (83% [CI, 80% to 86%]), Physicia
ns were significantly more likely than chief executives to indicate th
at hospital board members (81% and 68%; P < 0.001) and donors to hospi
tal foundations (63% and 42%; P < 0.001) would receive preferential ac
cess. Most respondents indicated that preferential access was more lik
ely to be provided if patients or families were well informed, aggress
ive, or potentially litigious. The survey did not permit estimation of
the frequency of episodes of preferential access. Conclusions: Althou
gh equality of access is a cornerstone principle of Canada's universal
health care system, some access to specialized cardiovascular service
s occurs preferentially on the basis of factors other than clinical ne
ed. The actual magnitude and consequences of this phenomenon remain un
known.