BACKGROUND The importance of access to healthcare for all is internationally recognised as a global goal, high on the global agenda. Yet inequalities in health exist within and between countries which are exacerbated by inequalities in access to healthcare. In order to address these inequalities, we need to better understand what drives them. While there exists a wealth of research on access to healthcare in different countries and contexts, and for different patient groups, to date no attempt has been made to bring this evidence together through a global lens. This study aims to address that gap by bringing together evidence of what factors affect patients' access to healthcare and exploring how those factors vary in different countries and contexts around the world. METHODS An overview of reviews will be conducted using a comprehensive search strategy to search four databases: Medline, Embase, Global Health and Cochrane Systematic Reviews. Additional searches will be conducted on the Gates Foundation, the World Health Organisation (WHO) and World Bank websites. Titles and abstracts will be screened against the eligibility criteria and full-text articles will be obtained for all records that meet the inclusion criteria or where there is uncertainty around eligibility. A data extraction table will be developed during the review process and will be piloted and refined before full data extraction commences. Methodological quality/risk of bias will be assessed for each included study using the AMSTAR 2 tool. The quality assessment will be used to inform the narrative synthesis, but a low-quality score will not necessarily lead to study exclusion. DISCUSSION Factors affecting patients' ability to access healthcare will be identified and analysed according to different country and context characteristics to shed light on the importance of different factors in different settings. Results will be interpreted accounting for the usual challenges associated with conducting such reviews. The results may guide future research in this area and contribute to priority setting for development initiatives aimed at ensuring equitable access to healthcare for all. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019144775.

中文翻译：

---

哪些因素影响患者获得医疗保健？系统审查概述的协议。

背景技术人人享有医疗保健的重要性已被国际公认是一项全球目标，已成为全球议程的重中之重。然而，国家内部和国家之间存在卫生不平等，而获得医疗保健的不平等加剧了这种不平等。为了解决这些不平等问题，我们需要更好地了解是什么导致了这些不平等。尽管在不同的国家和地区以及针对不同的患者群体进行了大量有关获得医疗保健的研究，但迄今为止，还没有尝试通过全球视角将这些证据整合在一起。这项研究旨在通过汇总哪些因素影响患者获得医疗保健的证据，并探讨这些因素在全球不同国家和地区的变化情况，来解决这一差距。方法将使用全面的搜索策略来搜索评论的概述，以搜索四个数据库：Medline，Embase，Global Health和Cochrane系统评论。其他搜索将在盖茨基金会，世界卫生组织（世卫组织）和世界银行网站上进行。将根据资格标准筛选标题和摘要，并为符合纳入标准或资格存在不确定性的所有记录获取全文文章。数据提取表将在审核过程中开发，并将在开始全面数据提取之前进行试点和完善。将使用AMSTAR 2工具评估每个纳入研究的方法学质量/偏倚风险。质量评估将用于为叙事综合提供信息，但是低质量的分数并不一定会导致研究被排除在外。讨论将根据不同的国家和背景特征来识别和分析影响患者获得医疗保健能力的因素，以阐明不同因素在不同环境中的重要性。将解释结果，解释与进行此类审查相关的常见挑战。结果可能指导该领域的未来研究，并有助于确定旨在确保所有人平等获得医疗保健的发展计划的优先级。系统审查注册PROSPERO CRD42019144775。将根据不同的国家和环境特征来确定和分析获得医疗保健的能力，以阐明不同环境中不同因素的重要性。将解释结果，解释与进行此类审查相关的常见挑战。结果可能指导该领域的未来研究，并有助于确定旨在确保所有人平等获得医疗保健的发展计划的优先级。系统审查注册PROSPERO CRD42019144775。将根据不同的国家和环境特征来确定和分析获得医疗保健的能力，以阐明不同环境中不同因素的重要性。将解释结果，解释与进行此类审查相关的常见挑战。结果可能指导该领域的未来研究，并有助于确定旨在确保所有人平等获得医疗保健的发展计划的优先级。系统审查注册PROSPERO CRD42019144775。结果可能指导该领域的未来研究，并有助于确定旨在确保所有人平等获得医疗保健的发展计划的优先级。系统审查注册PROSPERO CRD42019144775。结果可能指导该领域的未来研究，并有助于确定旨在确保所有人平等获得医疗保健的发展计划的优先级。系统审查注册PROSPERO CRD42019144775。