Public funding for private for-profit centres and access to cataract surgery by patient socioeconomic status: an Ontario population-based study.

Autor:	Campbell RJ; ICES (Campbell, Bell, Urbach, Paterson, Stukel, Gill, Baxter, Wilton, Gomez), Toronto, Ont.; Department of Ophthalmology (Campbell), Queen's University; Department of Ophthalmology (Campbell), Kingston Health Sciences Centre, Hotel Dieu Hospital site, Kingston, Ont.; Department of Ophthalmology (El-Defrawy), University of Toronto; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute; Department of Medicine (Bell), University of Toronto; Institute of Health Policy, Management and Evaluation (Bell, Paterson, Stukel), University of Toronto; Department of Medicine (Bell), Sinai Health System; Department of Surgery (Urbach, Baxter, Gomez), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Family Medicine, McMaster University, Hamilton, Ont.; Division of Geriatric Medicine (Gill), Queen's University; Division of Geriatric Medicine (Gill), Providence Care Hospital, Kingston, Ont.; Departments of Otolaryngology, Head and Neck Surgery and Surgical Oncology (Irish), University Health Network; Cancer Care Ontario (Irish); Li Ka Shing Knowledge Institute (Baxter, Gomez), St. Michael's Hospital, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, AU; Unity Health Toronto (Gomez), St. Michael's Hospital, Toronto, Ont. rob.campbell@queensu.ca., El-Defrawy SR; ICES (Campbell, Bell, Urbach, Paterson, Stukel, Gill, Baxter, Wilton, Gomez), Toronto, Ont.; Department of Ophthalmology (Campbell), Queen's University; Department of Ophthalmology (Campbell), Kingston Health Sciences Centre, Hotel Dieu Hospital site, Kingston, Ont.; Department of Ophthalmology (El-Defrawy), University of Toronto; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute; Department of Medicine (Bell), University of Toronto; Institute of Health Policy, Management and Evaluation (Bell, Paterson, Stukel), University of Toronto; Department of Medicine (Bell), Sinai Health System; Department of Surgery (Urbach, Baxter, Gomez), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Family Medicine, McMaster University, Hamilton, Ont.; Division of Geriatric Medicine (Gill), Queen's University; Division of Geriatric Medicine (Gill), Providence Care Hospital, Kingston, Ont.; Departments of Otolaryngology, Head and Neck Surgery and Surgical Oncology (Irish), University Health Network; Cancer Care Ontario (Irish); Li Ka Shing Knowledge Institute (Baxter, Gomez), St. Michael's Hospital, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, AU; Unity Health Toronto (Gomez), St. Michael's Hospital, Toronto, Ont., Bell CM; ICES (Campbell, Bell, Urbach, Paterson, Stukel, Gill, Baxter, Wilton, Gomez), Toronto, Ont.; Department of Ophthalmology (Campbell), Queen's University; Department of Ophthalmology (Campbell), Kingston Health Sciences Centre, Hotel Dieu Hospital site, Kingston, Ont.; Department of Ophthalmology (El-Defrawy), University of Toronto; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute; Department of Medicine (Bell), University of Toronto; Institute of Health Policy, Management and Evaluation (Bell, Paterson, Stukel), University of Toronto; Department of Medicine (Bell), Sinai Health System; Department of Surgery (Urbach, Baxter, Gomez), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Family Medicine, McMaster University, Hamilton, Ont.; Division of Geriatric Medicine (Gill), Queen's University; Division of Geriatric Medicine (Gill), Providence Care Hospital, Kingston, Ont.; Departments of Otolaryngology, Head and Neck Surgery and Surgical Oncology (Irish), University Health Network; Cancer Care Ontario (Irish); Li Ka Shing Knowledge Institute (Baxter, Gomez), St. Michael's Hospital, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, AU; Unity Health Toronto (Gomez), St. Michael's Hospital, Toronto, Ont., Urbach DR; ICES (Campbell, Bell, Urbach, Paterson, Stukel, Gill, Baxter, Wilton, Gomez), Toronto, Ont.; Department of Ophthalmology (Campbell), Queen's University; Department of Ophthalmology (Campbell), Kingston Health Sciences Centre, Hotel Dieu Hospital site, Kingston, Ont.; Department of Ophthalmology (El-Defrawy), University of Toronto; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute; Department of Medicine (Bell), University of Toronto; Institute of Health Policy, Management and Evaluation (Bell, Paterson, Stukel), University of Toronto; Department of Medicine (Bell), Sinai Health System; Department of Surgery (Urbach, Baxter, Gomez), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Family Medicine, McMaster University, Hamilton, Ont.; Division of Geriatric Medicine (Gill), Queen's University; Division of Geriatric Medicine (Gill), Providence Care Hospital, Kingston, Ont.; Departments of Otolaryngology, Head and Neck Surgery and Surgical Oncology (Irish), University Health Network; Cancer Care Ontario (Irish); Li Ka Shing Knowledge Institute (Baxter, Gomez), St. Michael's Hospital, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, AU; Unity Health Toronto (Gomez), St. Michael's Hospital, Toronto, Ont., Paterson JM; ICES (Campbell, Bell, Urbach, Paterson, Stukel, Gill, Baxter, Wilton, Gomez), Toronto, Ont.; Department of Ophthalmology (Campbell), Queen's University; Department of Ophthalmology (Campbell), Kingston Health Sciences Centre, Hotel Dieu Hospital site, Kingston, Ont.; Department of Ophthalmology (El-Defrawy), University of Toronto; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute; Department of Medicine (Bell), University of Toronto; Institute of Health Policy, Management and Evaluation (Bell, Paterson, Stukel), University of Toronto; Department of Medicine (Bell), Sinai Health System; Department of Surgery (Urbach, Baxter, Gomez), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Family Medicine, McMaster University, Hamilton, Ont.; Division of Geriatric Medicine (Gill), Queen's University; Division of Geriatric Medicine (Gill), Providence Care Hospital, Kingston, Ont.; Departments of Otolaryngology, Head and Neck Surgery and Surgical Oncology (Irish), University Health Network; Cancer Care Ontario (Irish); Li Ka Shing Knowledge Institute (Baxter, Gomez), St. Michael's Hospital, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, AU; Unity Health Toronto (Gomez), St. Michael's Hospital, Toronto, Ont., Stukel TA; ICES (Campbell, Bell, Urbach, Paterson, Stukel, Gill, Baxter, Wilton, Gomez), Toronto, Ont.; Department of Ophthalmology (Campbell), Queen's University; Department of Ophthalmology (Campbell), Kingston Health Sciences Centre, Hotel Dieu Hospital site, Kingston, Ont.; Department of Ophthalmology (El-Defrawy), University of Toronto; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute; Department of Medicine (Bell), University of Toronto; Institute of Health Policy, Management and Evaluation (Bell, Paterson, Stukel), University of Toronto; Department of Medicine (Bell), Sinai Health System; Department of Surgery (Urbach, Baxter, Gomez), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Family Medicine, McMaster University, Hamilton, Ont.; Division of Geriatric Medicine (Gill), Queen's University; Division of Geriatric Medicine (Gill), Providence Care Hospital, Kingston, Ont.; Departments of Otolaryngology, Head and Neck Surgery and Surgical Oncology (Irish), University Health Network; Cancer Care Ontario (Irish); Li Ka Shing Knowledge Institute (Baxter, Gomez), St. Michael's Hospital, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, AU; Unity Health Toronto (Gomez), St. Michael's Hospital, Toronto, Ont., Gill SS; ICES (Campbell, Bell, Urbach, Paterson, Stukel, Gill, Baxter, Wilton, Gomez), Toronto, Ont.; Department of Ophthalmology (Campbell), Queen's University; Department of Ophthalmology (Campbell), Kingston Health Sciences Centre, Hotel Dieu Hospital site, Kingston, Ont.; Department of Ophthalmology (El-Defrawy), University of Toronto; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute; Department of Medicine (Bell), University of Toronto; Institute of Health Policy, Management and Evaluation (Bell, Paterson, Stukel), University of Toronto; Department of Medicine (Bell), Sinai Health System; Department of Surgery (Urbach, Baxter, Gomez), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Family Medicine, McMaster University, Hamilton, Ont.; Division of Geriatric Medicine (Gill), Queen's University; Division of Geriatric Medicine (Gill), Providence Care Hospital, Kingston, Ont.; Departments of Otolaryngology, Head and Neck Surgery and Surgical Oncology (Irish), University Health Network; Cancer Care Ontario (Irish); Li Ka Shing Knowledge Institute (Baxter, Gomez), St. Michael's Hospital, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, AU; Unity Health Toronto (Gomez), St. Michael's Hospital, Toronto, Ont., Irish J; ICES (Campbell, Bell, Urbach, Paterson, Stukel, Gill, Baxter, Wilton, Gomez), Toronto, Ont.; Department of Ophthalmology (Campbell), Queen's University; Department of Ophthalmology (Campbell), Kingston Health Sciences Centre, Hotel Dieu Hospital site, Kingston, Ont.; Department of Ophthalmology (El-Defrawy), University of Toronto; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute; Department of Medicine (Bell), University of Toronto; Institute of Health Policy, Management and Evaluation (Bell, Paterson, Stukel), University of Toronto; Department of Medicine (Bell), Sinai Health System; Department of Surgery (Urbach, Baxter, Gomez), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Family Medicine, McMaster University, Hamilton, Ont.; Division of Geriatric Medicine (Gill), Queen's University; Division of Geriatric Medicine (Gill), Providence Care Hospital, Kingston, Ont.; Departments of Otolaryngology, Head and Neck Surgery and Surgical Oncology (Irish), University Health Network; Cancer Care Ontario (Irish); Li Ka Shing Knowledge Institute (Baxter, Gomez), St. Michael's Hospital, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, AU; Unity Health Toronto (Gomez), St. Michael's Hospital, Toronto, Ont., Baxter NN; ICES (Campbell, Bell, Urbach, Paterson, Stukel, Gill, Baxter, Wilton, Gomez), Toronto, Ont.; Department of Ophthalmology (Campbell), Queen's University; Department of Ophthalmology (Campbell), Kingston Health Sciences Centre, Hotel Dieu Hospital site, Kingston, Ont.; Department of Ophthalmology (El-Defrawy), University of Toronto; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute; Department of Medicine (Bell), University of Toronto; Institute of Health Policy, Management and Evaluation (Bell, Paterson, Stukel), University of Toronto; Department of Medicine (Bell), Sinai Health System; Department of Surgery (Urbach, Baxter, Gomez), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Family Medicine, McMaster University, Hamilton, Ont.; Division of Geriatric Medicine (Gill), Queen's University; Division of Geriatric Medicine (Gill), Providence Care Hospital, Kingston, Ont.; Departments of Otolaryngology, Head and Neck Surgery and Surgical Oncology (Irish), University Health Network; Cancer Care Ontario (Irish); Li Ka Shing Knowledge Institute (Baxter, Gomez), St. Michael's Hospital, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, AU; Unity Health Toronto (Gomez), St. Michael's Hospital, Toronto, Ont., Wilton AS; ICES (Campbell, Bell, Urbach, Paterson, Stukel, Gill, Baxter, Wilton, Gomez), Toronto, Ont.; Department of Ophthalmology (Campbell), Queen's University; Department of Ophthalmology (Campbell), Kingston Health Sciences Centre, Hotel Dieu Hospital site, Kingston, Ont.; Department of Ophthalmology (El-Defrawy), University of Toronto; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute; Department of Medicine (Bell), University of Toronto; Institute of Health Policy, Management and Evaluation (Bell, Paterson, Stukel), University of Toronto; Department of Medicine (Bell), Sinai Health System; Department of Surgery (Urbach, Baxter, Gomez), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Family Medicine, McMaster University, Hamilton, Ont.; Division of Geriatric Medicine (Gill), Queen's University; Division of Geriatric Medicine (Gill), Providence Care Hospital, Kingston, Ont.; Departments of Otolaryngology, Head and Neck Surgery and Surgical Oncology (Irish), University Health Network; Cancer Care Ontario (Irish); Li Ka Shing Knowledge Institute (Baxter, Gomez), St. Michael's Hospital, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, AU; Unity Health Toronto (Gomez), St. Michael's Hospital, Toronto, Ont., Gomez D; ICES (Campbell, Bell, Urbach, Paterson, Stukel, Gill, Baxter, Wilton, Gomez), Toronto, Ont.; Department of Ophthalmology (Campbell), Queen's University; Department of Ophthalmology (Campbell), Kingston Health Sciences Centre, Hotel Dieu Hospital site, Kingston, Ont.; Department of Ophthalmology (El-Defrawy), University of Toronto; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute; Department of Medicine (Bell), University of Toronto; Institute of Health Policy, Management and Evaluation (Bell, Paterson, Stukel), University of Toronto; Department of Medicine (Bell), Sinai Health System; Department of Surgery (Urbach, Baxter, Gomez), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Family Medicine, McMaster University, Hamilton, Ont.; Division of Geriatric Medicine (Gill), Queen's University; Division of Geriatric Medicine (Gill), Providence Care Hospital, Kingston, Ont.; Departments of Otolaryngology, Head and Neck Surgery and Surgical Oncology (Irish), University Health Network; Cancer Care Ontario (Irish); Li Ka Shing Knowledge Institute (Baxter, Gomez), St. Michael's Hospital, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, AU; Unity Health Toronto (Gomez), St. Michael's Hospital, Toronto, Ont.
Jazyk:	angličtina
Zdroj:	CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne [CMAJ] 2024 Aug 25; Vol. 196 (28), pp. E965-E972. Date of Electronic Publication: 2024 Aug 25.
DOI:	10.1503/cmaj.240414
Abstrakt:	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. Competing Interests: Competing interests:: Jonathan Irish is a board member with the Canadian Cancer Society. No other competing interests were declared. (© 2024 CMA Impact Inc. or its licensors.)
Databáze:	MEDLINE
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