CASE: 

The mother of an 18-month-old boy contacted the developmental and behavioral pediatrics clinic to request an evaluation because of concerns that her son is not using any words and only recently began walking. The child's mother became upset when she was notified that the clinic policy requires receipt of a formal request for evaluation from the primary care physician and that the first available appointment was in 9 months. Later that day, the child's grandmother contacted the clinic and reported that she is a member of the Donor Society affiliated with the university/medical system. Membership in the Donor Society is granted to individuals who have met specific philanthropic thresholds benefiting the university. One benefit to members of the Donor Society is the ability to access subspecialty medical services for themselves and their family members, across all disciplines, within 5 business days of their request.

After confirming the details of the Donor Society promise with the philanthropic department of the hospital, a small committee of professionals within the clinic gathered to discuss the implications of this promised benefit to Donor Society members. This clinic is the only source for specialized, multidisciplinary developmental-behavioral health care that accepts public insurance within a 200-mile radius. The current waitlist for evaluation is 9 to 15 months depending on the reason for referral, and approximately 75% of patients on the waitlist receive some form of public assistance and/or live in a rural or underserved area. During the discussion, it was noted that there are 2 developmental-behavioral pediatric clinicians who practice within a cash-based private practice setting in the community. The waitlist for that practice was recently reported to be 3 to 6 months depending on the reason for evaluation, but that practice also requires a referral from the primary care physician before scheduling an initial evaluation.

How would you recommend that the clinicians in the developmental and behavioral pediatrics clinic respond to the request to fulfill the promises made by the university to members of the Donor Society? How does a promise such as this one made to the Donor Society affect structural inequalities within the health care system and what strategies could be used to mitigate further inequalities that may result?

中文翻译：

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免排队：获得发展行为护理方面的不平等

案件： 

一名 18 个月大男孩的母亲联系发育和行为儿科诊所要求进行评估，因为担心她的儿子不会说话，而且最近才开始走路。当孩子的母亲被告知诊所政策要求收到初级保健医生的正式评估请求并且第一次可用的预约是在 9 个月后时，她感到很不安。当天晚些时候，孩子的祖母联系了诊所，并报告说她是大学/医疗系统附属捐赠者协会的成员。捐助者协会的会员资格授予那些达到使大学受益的特定慈善门槛的个人。捐助协会成员的一项好处是能够在提出请求后 5 个工作日内为自己及其家人获得所有学科的亚专科医疗服务。

在与医院慈善部门确认捐赠者协会承诺的细节后，诊所内的一个由专业人士组成的小型委员会聚集在一起讨论这一承诺的福利对捐赠者协会成员的影响。该诊所是唯一接受 200 英里半径内公共保险的专业、多学科发展行为医疗保健来源。目前的评估等候名单为 9 至 15 个月，具体取决于转诊原因，等候名单上大约 75% 的患者接受某种形式的公共援助和/或生活在农村或服务不足的地区。在讨论过程中，有人指出，有 2 名发育行为儿科临床医生在社区的现金私人诊所中执业。据最近报道，该诊所的候补名单为 3 至 6 个月，具体取决于评估的原因，但该诊所还需要初级保健医生的转介，然后才能安排初步评估。

您建议发育和行为儿科诊所的临床医生如何回应要求，以履行大学向捐赠者协会成员做出的承诺？像向捐助协会做出的这样的承诺如何影响医疗保健系统内的结构性不平等？可以使用哪些策略来减轻可能导致的进一步不平等？