卫生资源配置决策的非正式制度的影响研究——基于对隐性优先分配规则的思考
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摘要
健康中国2030成为十三五及更长时期的重大国家战略,卫生资源配置决策则是国家卫生治理战略的重要环节。卫生资源优先次序分配不可避免,特别是卫生需求大而国家卫生总费用较少的国家。资源分配决策的优先规则受到一个社会所认同和秉持的价值观影响。多数国家的卫生决策优先规则是隐秘的,这些优先分配潜规则形塑了分配决策的非正式制度,嵌入并影响国家卫生正式制度,共同决定了卫生资源的优先分配。隐性优先分配规则的显化,有助于回应优先分配所面临的伦理抉择冲突,并让实践遵从卫生系统的价值指引。通过比较多种卫生资源优先分配规则,探寻我国适切的优先规则,旨在为健康中国进程中的卫生善治提供伦理基础和价值判断。
Healthy China 2030 has become a key national strategy since the 13 th Five-Year Plan,and the health resources allocation decision making is vital for the national healthy strategy.The priority setting in health resource is unavoidable especially in the countries with larger health demand but less domestic health resources,while the rationing priority rules is often influenced by a social common sense and values.The priority rules for health decision-making in most countries are implicit rather than explicit, while the implicit rules shape the potential informal system embedded in and influence the formal national health system, and together affect the health rationing. The externalization of implicit priority setting rules helps to settle the ethical conflicts in rationing, and further clarifies the implementation path to the value guidance in the health system. Through the comparative analysis of priority rules and related outcome,the possible priority rule for China's health rationing was proposed, which provide an ethical foundation and value reference for good governance of implementing healthy China plan.
Healthy China 2030 has become a key national strategy since the 13 th Five-Year Plan,and the health resources allocation decision making is vital for the national healthy strategy.The priority setting in health resource is unavoidable especially in the countries with larger health demand but less domestic health resources,while the rationing priority rules is often influenced by a social common sense and values.The priority rules for health decision-making in most countries are implicit rather than explicit, while the implicit rules shape the potential informal system embedded in and influence the formal national health system, and together affect the health rationing. The externalization of implicit priority setting rules helps to settle the ethical conflicts in rationing, and further clarifies the implementation path to the value guidance in the health system. Through the comparative analysis of priority rules and related outcome,the possible priority rule for China's health rationing was proposed, which provide an ethical foundation and value reference for good governance of implementing healthy China plan.
引文
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[3][美]约翰·罗尔斯.政治自由主义[M].万俊人译.上海:译林出版社,2000.57.
[4][英]阿克顿.自由史论.胡传胜等译[M].上海:译林出版社,2001.181.
[5]Hoedemaekers,R,Gordijn,B,Pijnenburg,M.Solidarity and Justice as Guiding Principles in Genomic Research.Bioethics,2007,21(6).
[6]沃利.发展中国家改善公共卫生指南[M].北京:北京大学出版社,2009.83-84.
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[9]Persad G,Wertheimer A,Emanuel E J.Principles for Allocation of Scarce Medical Interventions.Lancet,2009,373(9661).
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