Influences of organizational features of healthcare settings on clinical decision making: qualitative results from a cross-national factorial experiment.
Influences of organizational features of healthcare settings on clinical decision making: qualitative results from a cross-national factorial experiment.
复制标题
DOI：
10.1177/1363459310371079
复制
发表时间：
2012-01
期刊：
影响因子：
--
通讯作者：
McKinlay JB
中科院分区：
文献类型：
--
作者：
Lutfey KE;Campbell SM;Marceau LD;Roland MO;McKinlay JB
A proliferating literature documents cross-national variation in medical practice and seeks to explain observed differences in terms of the presence of certain kinds of healthcare systems, economic, and cultural differences between countries. Less is known about how providers themselves understand these influences and perceive them as relevant to their clinical work. Using qualitative data from a cross-national factorial experiment in the United States and United Kingdom, we analyze 244 primary care physicians’ explanations of how organizational features of their respective healthcare settings influence the treatment decisions they made for a vignette patient, including affordability of care; within-system quality deficits; and constraints due to patient behavior. While many differences are attributed to financial constraints deriving from two very differently structured healthcare systems, in other ways they are reflections of cultural and historical expectations regarding medical care, or interactions between the two. Implications, including possible challenges to the implementation of universal care in the US, are discussed.
