Why do some physicians choose to tackle inequities in healthcare?

Abstract

BackgroundDespite the reputation of Canada’s healthcare system as being accessible to all Canadians, certain populations continue to face inequities within our healthcare system. In addition to promoting fairness, addressing healthcare inequities has the potential to reduce healthcare costs, which is increasingly important as healthcare costs continue to rise. Intentionally or otherwise, physicians are often leaders in healthcare teams, but there is a paucity of literature on physicians’ perceptions of the problem of healthcare inequities and their potential role in addressing inequities. In this pilot study, we use a grounded theory approach to explore contextual factors and mechanisms that associate with an individual physician’s involvement (or otherwise) in initiatives to reduce healthcare inequity.MethodsUsing purposeful sampling and a set of a priori questions, we interviewed ten physicians – five of whom self-identified as being actively involved and five not actively involved in addressing healthcare inequities – to explore potential reasons for physicians choosing to address the causes of healthcare inequities.ResultsWe identified contextual barriers (e.g., lack of knowledge and time) and facilitators (prior experience, protected time, mentorship and system supports) that we interpreted as interacting with the underlying mechanism (motivation to address inequities) to influence a physician’s decision on whether or not to address healthcare inequities.ConclusionBased upon our findings we propose further studies to understand and/or overcome barriers to physicians being involved in addressing healthcare inequities.

Attitudes on Equal Health Care Access versus Efficient Clinical Decisions across a Not-for-Profit Health Care System

“…14 The difference between clinician and nonclinician responses can perhaps be explained by the priority clinicians place on their ethical responsibility to serve all patients equitably, an ethical value highlighted in their medical training with its emphasis in the Hippocratic Oath and Nightingale Pledge. 15,16 In addition, some physicians think that “doctors are ethically and morally responsible to promote care for all types of patients.” 17 Finally, one study found that clinicians made better quality decisions than nonclinical personnel did in uncertain probabilistic scenarios, possibly due to varying emotional affect or the “agent affect” (i.e., making decisions for others may involve different levels of loss aversion, with which clinicians may be more comfortable). 18…”

“…15,16 In addition, some physicians think that ''doctors are ethically and morally responsible to promote care for all types of patients.'' 17 Finally, one study found that clinicians made better quality decisions than nonclinical personnel did in uncertain probabilistic scenarios, possibly due to varying emotional affect or the ''agent affect'' (i.e., making decisions for others may involve different levels of loss aversion, with which clinicians may be more comfortable). 18 In our study, men were significantly more likely to prefer the efficiency option.…”

Population Health Intervention Implementation Among Migrants With Precarious Status in Montreal: Underlying Theory and Key Challenges

“…Nonetheless, inequities exist for many segments of the population, including refugees. Difficulties accessing health care are directly linked to immigration status (Brabant & Raynault, 2012a;Nkunu & McLaughlin, 2018). In other words, health coverage varies depending on immigration status: private insurance for visitors and students; Interim Federal Health Program (IFHP) for asylum seekers; and a 3-month waiting period for those who qualify for Medicare (RAMQ), that is, permanent residents and temporary foreign workers.…”