An evaluation of horizontal equity in surgical care for gallstone disease in a Caribbean country

Abstract

Background: The aim of this study was to identify social injustice by evaluating horizontal equity (allocation of similar resources to patients with the same clinical needs) in surgical care for gallstone disease in a Caribbean Country. Methods: We compared access to laparoscopic cholecystectomy (LC) for gallstone disease between a fee-for-service (private) and a government-funded (public) health-care system between 1st January and 31st August, 2018. We defined a prolonged waiting time as an interval of >90 days between the index diagnosis and LC. The data were examined using SPSS v23. Results: Ninety-nine patients underwent LC in public (60) or private (39) hospitals. There was a significantly longer mean waiting time in public hospitals (336.4 ± 647.9 days vs. 20.2 ± 25.5 days; P 0.002) and significantly more hospital readmissions while awaiting LC (72% vs. 0%). In the public hospital system, fewer patients had ambulatory operations (8.4% vs. 51.3%; P 90 days while awaiting insurance pre-authorisation. Conclusion: Horizontal inequity exists between the health-care systems. There is room for improvement through increased accountability for administrators, better resource allocation, proper equipment maintenance schedules and efforts to reduce waiting lists.

Keywords

• equity
• healthcare
• social