A SURVEY OF PROVIDER EXPERIENCES AND PERCEPTIONS OF PREFERENTIAL ACCESS TO CARDIOVASCULAR CARE IN ONTARIO, CANADA

Citation
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
Citations number
23
Categorie Soggetti
Medicine, General & Internal
Journal title
ISSN journal
00034819
Volume
129
Issue
7
Year of publication
1998
Pages
567 - 572
Database
ISI
SICI code
0003-4819(1998)129:7<567:ASOPEA>2.0.ZU;2-4
Abstract
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.