The north is not all the same: comparing health system performance in 18 northern regions of Canada
The north is not all the same: comparing health system performance in 18 northern regions of Canada
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DOI：
10.1080/22423982.2019.1697474
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发表时间：
2019-01-01
影响因子：
1.3
通讯作者：
Marchildon, Gregory P.
中科院分区：
文献类型：
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作者：
Young, T. Kue;Chatwood, Susan;Marchildon, Gregory P.
我们调查了加拿大18个北方地区卫生系统绩效指标数据的可用性，以及使用加拿大卫生信息研究所[CIHI]开发的绩效框架的可行性。我们研究了24个指标在不同地区的差异以及可能解释这种差异的因素。这18个地区在人口规模和社会经济地位、保健服务和健康状况的各种衡量标准方面各不相同。卫生系统表现最差的地区一般包括努纳武特和魁北克、马尼托巴和萨斯喀彻温省的北方地区，这些地区的土著人占人口的绝大多数，从70%到90%不等，他们在不利的社会决定因素方面也表现最差。所有北方地区在因门诊护理敏感疾病住院治疗和潜在可避免的死亡率方面的表现都比加拿大全国差。人口规模、社会经济地位、城市化程度和原住民在人口中的比例都与绩效相关。北半球远非同质化。区域间的差异需要进一步研究。更多的中间途径，特别是卫生系统投入、产出和成果之间的中间途径，基本上尚未探索。要改善北方和偏远地区的卫生系统业绩，就需要土著领导人、社区和病人代表的参与。
We investigated the availability of health system performance indicator data in Canada's 18 northern regions and the feasibility of using the performance framework developed by the Canadian Institute for Health Information [CIHI]. We examined the variation in 24 indicators across regions and factors that might explain such variation. The 18 regions vary in population size and various measures of socioeconomic status, health-care delivery, and health status. The worst performing health systems generally include Nunavut and the northern regions of Quebec, Manitoba and Saskatchewan where indigenous people constitute the overwhelming majority of the population, ranging from 70% to 90%, and where they also fare worst in terms of adverse social determinants. All northern regions perform worse than Canada nationally in hospitalisations for ambulatory care sensitive conditions and potentially avoidable mortality. Population size, socioeconomic status, degree of urbanisation and proportion of Aboriginal people in the population are all associated with performance. The North is far from homogenous. Inter-regional variation demands further investigation. The more intermediate pathways, especially between health system inputs, outputs and outcomes, are largely unexplored. Improvement of health system performance for northern and remote regions will require the engagement of indigenous leadership, communities and patient representatives.