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Updated: May 22, 2025

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産婦人科外来診療における支払者に基づく分離：質、安全性、および公平性への影響

Suzanna Larkin1, Erika Harness, Kavita Shah Arora

  • 1Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Sidney Kimmel Medical College, Thomas Jefferson University, the Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, and the Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; Family Planning, School of Medicine, University of Connecticut, Farmington, Connecticut; the Department of Obstetrics and Gynecology, NYU Long Island Grossman School of Medicine, Langone Health, Mineola, New York; and the Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine, University of Vermont, Burlington, Vermont.

Obstetrics and gynecology
|March 13, 2025
PubMed

外来診療における保険加入状況による患者の選別は、アカデミック・メディシンにおける長年の慣行である。レジデントの外来診療と指導医の外来診療の間で、支払者に基いたこのような患者の分離が行われることは、ケアの質の不平等につながる可能性がある。2023年の米国産婦人科専門医資格試験（in-service examination）において、レジデントおよびプログラムディレクターを対象とした自由記述形式の質問に対する回答に基づき、我々は産婦人科領域におけるこの構造的不平等について論評を行う。本論評の目的は、診療対象となる患者層の違い、レジデント外来におけるリソースの不足、ケアの質とモラル・インジュリー（道徳的損害）、限定的なケアの継続性、およびトレーニングと指導について検討することである。体系的な統合に向けた取り組みを導き、プログラムの統合が患者の健康アウトカムに及ぼす影響を調査するためには、さらなる研究が必要である。それにもかかわらず、我々はアカデミック・メディカルセンターに対し、支払者に依存しない統合的なケアへの組織的転換を検討することを強く促す。

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