Robert J Campbell, Sherif R El-Defrawy, Chaim M Bell, David R Urbach, J Michael Paterson, Therese A Stukel, Sudeep S Gill, Jonathan Irish, Nancy N Baxter, Andrew S Wilton, David Gomez
{"title":"按患者社会经济地位划分的私立营利性中心的公共资金和接受白内障手术的机会：一项基于安大略省人口的研究。","authors":"Robert J Campbell, Sherif R El-Defrawy, Chaim M Bell, David R Urbach, J Michael Paterson, Therese A Stukel, Sudeep S Gill, Jonathan Irish, Nancy N Baxter, Andrew S Wilton, David Gomez","doi":"10.1503/cmaj.240414","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Public funding of cataract surgery provided in private, for-profit surgical centres increased to help mitigate surgical backlogs during the COVID-19 pandemic in Ontario, Canada. We sought to compare the socioeconomic status of patients who underwent cataract surgery in not-for-profit public hospitals with those who underwent this surgery in private for-profit surgical centres and to evaluate whether differences in access by socioeconomic status decreased after the infusion of public funding for private, for-profit centres.</p><p><strong>Methods: </strong>We conducted a population-based study of all cataract operations in Ontario, Canada, between January 2017 and March 2022. We analyzed differences in socioeconomic status among patients who accessed surgery at not-for-profit public hospitals versus those who accessed it at private for-profit surgical centres before and during the period of expanded public funding for private for-profit centres.</p><p><strong>Results: </strong>Overall, 935 729 cataract surgeries occurred during the study period. Within private for-profit surgical centres, the rate of cataract surgeries rose 22.0% during the funding change period for patients in the highest socioeconomic status quintile, whereas, for patients in the lowest socioeconomic status quintile, the rate fell 8.5%. In contrast, within public hospitals, the rate of surgery decreased similarly among patients of all quintiles of socioeconomic status. During the funding change period, 92 809 fewer cataract operations were performed than expected. This trend was associated with socioeconomic status, particularly within private for-profit surgical centres, where patients with the highest socioeconomic status were the only group to have an increase in cataract operations.</p><p><strong>Interpretation: </strong>After increased public funding for private, for-profit surgical centres, patient socioeconomic status was associated with access to cataract surgery in these centres, but not in public hospitals. Addressing the factors underlying this incongruity is vital to ensure access to surgery and maintain public confidence in the cataract surgery system.</p>","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":null,"pages":null},"PeriodicalIF":9.4000,"publicationDate":"2024-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349346/pdf/","citationCount":"0","resultStr":"{\"title\":\"Public funding for private for-profit centres and access to cataract surgery by patient socioeconomic status: an Ontario population-based study.\",\"authors\":\"Robert J Campbell, Sherif R El-Defrawy, Chaim M Bell, David R Urbach, J Michael Paterson, Therese A Stukel, Sudeep S Gill, Jonathan Irish, Nancy N Baxter, Andrew S Wilton, David Gomez\",\"doi\":\"10.1503/cmaj.240414\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Public funding of cataract surgery provided in private, for-profit surgical centres increased to help mitigate surgical backlogs during the COVID-19 pandemic in Ontario, Canada. We sought to compare the socioeconomic status of patients who underwent cataract surgery in not-for-profit public hospitals with those who underwent this surgery in private for-profit surgical centres and to evaluate whether differences in access by socioeconomic status decreased after the infusion of public funding for private, for-profit centres.</p><p><strong>Methods: </strong>We conducted a population-based study of all cataract operations in Ontario, Canada, between January 2017 and March 2022. We analyzed differences in socioeconomic status among patients who accessed surgery at not-for-profit public hospitals versus those who accessed it at private for-profit surgical centres before and during the period of expanded public funding for private for-profit centres.</p><p><strong>Results: </strong>Overall, 935 729 cataract surgeries occurred during the study period. Within private for-profit surgical centres, the rate of cataract surgeries rose 22.0% during the funding change period for patients in the highest socioeconomic status quintile, whereas, for patients in the lowest socioeconomic status quintile, the rate fell 8.5%. In contrast, within public hospitals, the rate of surgery decreased similarly among patients of all quintiles of socioeconomic status. During the funding change period, 92 809 fewer cataract operations were performed than expected. This trend was associated with socioeconomic status, particularly within private for-profit surgical centres, where patients with the highest socioeconomic status were the only group to have an increase in cataract operations.</p><p><strong>Interpretation: </strong>After increased public funding for private, for-profit surgical centres, patient socioeconomic status was associated with access to cataract surgery in these centres, but not in public hospitals. Addressing the factors underlying this incongruity is vital to ensure access to surgery and maintain public confidence in the cataract surgery system.</p>\",\"PeriodicalId\":9609,\"journal\":{\"name\":\"Canadian Medical Association journal\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":9.4000,\"publicationDate\":\"2024-08-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349346/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Canadian Medical Association journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1503/cmaj.240414\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Canadian Medical Association journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1503/cmaj.240414","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Public funding for private for-profit centres and access to cataract surgery by patient socioeconomic status: an Ontario population-based study.
Background: Public funding of cataract surgery provided in private, for-profit surgical centres increased to help mitigate surgical backlogs during the COVID-19 pandemic in Ontario, Canada. We sought to compare the socioeconomic status of patients who underwent cataract surgery in not-for-profit public hospitals with those who underwent this surgery in private for-profit surgical centres and to evaluate whether differences in access by socioeconomic status decreased after the infusion of public funding for private, for-profit centres.
Methods: We conducted a population-based study of all cataract operations in Ontario, Canada, between January 2017 and March 2022. We analyzed differences in socioeconomic status among patients who accessed surgery at not-for-profit public hospitals versus those who accessed it at private for-profit surgical centres before and during the period of expanded public funding for private for-profit centres.
Results: Overall, 935 729 cataract surgeries occurred during the study period. Within private for-profit surgical centres, the rate of cataract surgeries rose 22.0% during the funding change period for patients in the highest socioeconomic status quintile, whereas, for patients in the lowest socioeconomic status quintile, the rate fell 8.5%. In contrast, within public hospitals, the rate of surgery decreased similarly among patients of all quintiles of socioeconomic status. During the funding change period, 92 809 fewer cataract operations were performed than expected. This trend was associated with socioeconomic status, particularly within private for-profit surgical centres, where patients with the highest socioeconomic status were the only group to have an increase in cataract operations.
Interpretation: After increased public funding for private, for-profit surgical centres, patient socioeconomic status was associated with access to cataract surgery in these centres, but not in public hospitals. Addressing the factors underlying this incongruity is vital to ensure access to surgery and maintain public confidence in the cataract surgery system.
期刊介绍：
CMAJ (Canadian Medical Association Journal) is a peer-reviewed general medical journal renowned for publishing original research, commentaries, analyses, reviews, clinical practice updates, and editorials. Led by Editor-in-Chief Dr. Kirsten Patrick, it has a significant impact on healthcare in Canada and globally, with a 2022 impact factor of 17.4.
Its mission is to promote knowledge vital for the health of Canadians and the global community, guided by values of service, evidence, and integrity. The journal's vision emphasizes the importance of the best evidence, practice, and health outcomes.
CMAJ covers a broad range of topics, focusing on contributing to the evidence base, influencing clinical practice, and raising awareness of pressing health issues among policymakers and the public. Since 2020, with the appointment of a Lead of Patient Involvement, CMAJ is committed to integrating patients into its governance and operations, encouraging their content submissions.
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