title: Equity of access to elective surgery: reflections from NZ clinicians.
abstract: OBJECTIVE
  To explore factors potentially influencing equitable access to elective surgery in New Zealand by describing clinicians' perceptions of equity and the factors they consider when prioritising patients for elective surgery.
  
  
  METHODS
  A qualitative study in selected New Zealand localities. A purposive sample of 49 general practitioners, specialists and registrars were interviewed. Data were analysed thematically.
  
  
  RESULTS
  General practitioners described unequal opportunities for patients to access primary and secondary care and, in particular, private sector elective surgery. They felt that socio-economically disadvantaged patients were less able to advocate for themselves and were more vulnerable to being lost to the elective surgical booking system as well as being less able to access private care. Both GPs and secondary care clinicians described situations where they would personally advocate for individual patients to improve their access. Advocacy was related to clinicians' perceptions of the 'value' that patients would receive from the surgery and patients' needs for public sector funding.
  
  
  CONCLUSIONS
  The structure of the health system contributes to inequities in access to elective care in New Zealand. Subjective decision making by clinicians has the potential to advantage or disadvantage patients through the weighting clinicians place on socio-demographic factors when making rationing decisions. Review of the potential structural barriers to equitable access, further public debate and guidance for clinicians on the relative importance of socio-demographic factors in deciding access to rationed services are required for allocation of services to be fair.
authors.affiliation: Department of General Practice, Wellington School of Medicine, University of Otago, PO Box 7343, Wellington South, New Zealand.
authors.forename: Deborah
authors.initials: D
authors.lastname: McLeod
authors.forename: Kevin
authors.initials: K
authors.lastname: Dew
authors.forename: Sonya
authors.initials: S
authors.lastname: Morgan
authors.forename: Anthony
authors.initials: A
authors.lastname: Dowell
authors.forename: Jackie
authors.initials: J
authors.lastname: Cumming
authors.forename: Donna
authors.initials: D
authors.lastname: Cormack
authors.forename: Eileen
authors.initials: E
authors.lastname: McKinlay
authors.forename: Tom
authors.initials: T
authors.lastname: Love
mesh_terms: D001291:Attitude of Health Personnel; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D020793:Gatekeeping / Q000941:ethics; D015276:Health Care Rationing / Q000941:ethics; D006297:Health Services Accessibility / Q000941:ethics*; D006302:Health Services Research; D006801:Humans; D009520:New Zealand; D018579:Patient Selection / Q000941:ethics*; D010821:Physicians, Family / Q000523:psychology*; D036301:Qualitative Research; D012935:Social Justice