Cervera Soto S, Viñes Rueda J J
Universidad Pública de Navarra.
Rev Esp Salud Publica. 1999 Jan-Feb;73(1):13-24.
This study discusses the conviction that the qualitative change which is going to be taking place over the next few decades with regard to the practice of medicine as far as the four governing aspects which bear an impact on medical practice are concerned: pure applied science; health-care policies; the economy and ethics. Medical science's know-how is going to be applied based on scientific evidence, the empirical scientific approach that has characterized medical practice over the past century being replaced. The health care policies from the organized society (Public Health Care System) are going to be changing its centralized models, handing over management authorities to the health-care professionals proper working at the public medical centers oriented toward health-care objectives. In turn, the health-care administration is going to be demanding a greater deal of strictness with regard to the honoring of health-care benefits based on scientific proof. The health-care economy of the Public Health-Care System is going to be requiring that the prescribing of medical procedures and the implementation of new technologies be dealt with based on results-based proven effectiveness related to health and, therefore, efficiency in management terms is going to be replaced by cost-effectiveness. Finally, the trend in individual medical ethics is going to continue evolving due to the many different individual and group ethics, which, in defense of the very nature (physis) of the medical practice is going to be requiring the development of informed consent, conscientious objection and a consensus being reached regarding new codes of professional conduct of a universal scope.
本研究探讨了一种观点，即在未来几十年里，医学实践在对医疗实践产生影响的四个主要方面将发生质的变化：纯应用科学、医疗保健政策、经济和伦理。医学科学知识将基于科学证据来应用，过去一个世纪以来作为医学实践特征的经验科学方法将被取代。有组织社会（公共医疗保健系统）的医疗保健政策将改变其集中模式，将管理权力移交给以医疗保健目标为导向的公共医疗中心的专业医护人员。相应地，医疗保健管理将对基于科学证据的医疗保健福利的兑现要求更高的严格性。公共医疗保健系统的医疗保健经济将要求根据与健康相关的基于结果的已证实有效性来处理医疗程序的开出处方和新技术的实施，因此，管理方面的效率将被成本效益所取代。最后，由于许多不同的个人和群体伦理观念，个人医学伦理的趋势将继续演变，为了维护医疗实践的本质（自然），这将要求发展知情同意、良心拒绝，并就具有普遍范围的新专业行为准则达成共识。
