从公平走向正义:双向转诊逆阻现象及其对策的伦理分析
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摘要
在全面阐释首诊过场化现象、下转空泛化现象和下沉花瓶化现象及其不良后果的基础上,深入分析双向转诊实施环节中极端功利主义对公平原则的违背,明确指出首诊过程中的极端行为功利主义、下转过程中的极端交换功利主义和下沉过程中的极端制度功利主义是双向转诊逆阻现象的主要伦理成因,明确提出应当基于正义原则建立对称性首诊惩罚制度、公益性下转考核制度和正义性下沉评估制度,有效抑制双向转诊逆阻现象,以优化医疗资源配置和提高医疗服务可及性。
Based on the comprehensive clarification of reverse block phenomenon of two-way referral such as formalization of first diagnosis,generalization of patients' downward and superficiality of doctors' transferring to primary medical institution,the negative consequences brought by above-mentioned phenomena were discussed.This article analyzed indepth of the violation of the principle of fairness by extreme utilitarianism in the implementation of two-way referral.It also specified explicitly that the main causes were formed by extreme behavior utilitarianism during the course of first diagnosis,extreme system utilitarianism during the course of patients' downward and extreme exchange utilitarianism during the course of doctors' transferring to primary medical institution.For the sake of effectively restraining the reverse block phenomenon of two-way referral,optimizing the allocation of medical resources,and improving the accessibility of medical services,countermeasures such as symmetric punishment system of first diagnosis,commonweal assessment system of patients' downward and justice evaluation system of doctors' transferring to primary medical institution were proposed.
Based on the comprehensive clarification of reverse block phenomenon of two-way referral such as formalization of first diagnosis,generalization of patients' downward and superficiality of doctors' transferring to primary medical institution,the negative consequences brought by above-mentioned phenomena were discussed.This article analyzed indepth of the violation of the principle of fairness by extreme utilitarianism in the implementation of two-way referral.It also specified explicitly that the main causes were formed by extreme behavior utilitarianism during the course of first diagnosis,extreme system utilitarianism during the course of patients' downward and extreme exchange utilitarianism during the course of doctors' transferring to primary medical institution.For the sake of effectively restraining the reverse block phenomenon of two-way referral,optimizing the allocation of medical resources,and improving the accessibility of medical services,countermeasures such as symmetric punishment system of first diagnosis,commonweal assessment system of patients' downward and justice evaluation system of doctors' transferring to primary medical institution were proposed.
引文
[1]王静,孙瑞玲.从供给侧结构性改革视角看三级医院医疗资源下沉[J].中国医院管理,2016,36(11):30-32.
[2]张涵之.事实与价值的融合:伊斯顿后行为主义研究方法的内在逻辑[J].武汉大学学报:哲学社会科学版,2016,69(2):23-28.
[3]龚群.黑尔的行动功利主义辩护[J].学术月刊,2014,46(7):50-59.
[4]周啸天.行为、结果无价值理论哲学根基正本清源[J].政治与法律,2015(1):25-41.
[5]李银才.制度结构视角下的分级诊疗形成机制改革[J].现代经济探讨,2015(7):53-57.
[6]刘佳,冯泽永.社区首诊制的实施困境分析及对策研究[J].中国全科医学,2012,15(3A):720-722.
[7]陈娜,王长青.基于社会交换理论的中医药社区卫生服务共同体探索与实践[J].中国卫生事业管理,2015(8):574-576.
[8]孙统达,李冠伟,卢素芬,等.基层医疗机构公共财政分类补偿机制研究[J].中国农村卫生事业管理,2011,31(9):936-937.
[9]王云岭,高鉴国.当下公立医院缘何难以回归公益性[J].探索与争鸣,2015(5):46-50.
[2]张涵之.事实与价值的融合:伊斯顿后行为主义研究方法的内在逻辑[J].武汉大学学报:哲学社会科学版,2016,69(2):23-28.
[3]龚群.黑尔的行动功利主义辩护[J].学术月刊,2014,46(7):50-59.
[4]周啸天.行为、结果无价值理论哲学根基正本清源[J].政治与法律,2015(1):25-41.
[5]李银才.制度结构视角下的分级诊疗形成机制改革[J].现代经济探讨,2015(7):53-57.
[6]刘佳,冯泽永.社区首诊制的实施困境分析及对策研究[J].中国全科医学,2012,15(3A):720-722.
[7]陈娜,王长青.基于社会交换理论的中医药社区卫生服务共同体探索与实践[J].中国卫生事业管理,2015(8):574-576.
[8]孙统达,李冠伟,卢素芬,等.基层医疗机构公共财政分类补偿机制研究[J].中国农村卫生事业管理,2011,31(9):936-937.
[9]王云岭,高鉴国.当下公立医院缘何难以回归公益性[J].探索与争鸣,2015(5):46-50.