Hayes-Bautista D E
Am J Health Plann. 1977 Jan;1(3):36-44.
Marginal patients are those who are either denied access to medical care or who have chosen not to utilize medical care for their health problems. Marginal delivery systems have at times been developed by these marginal patients to meet their own needs as they define them. The structure and ideas of eight such marginal systems in Alameda County, California, are examined. Structurally, these systems are characterized by their notions of mandate, their unique development and evolution, individuality, independence, consumer control and short existence. The ideas held in these systems include new definitions of health, an expanded definition of appropriate health promoting activities, different definitions of clientele groups, new notions of division of labor and personnel, new forms of governance and decision making, different insights into the financing of health care and refreshingly new notions of medical politics.
边缘患者是指那些要么被拒绝获得医疗服务，要么因自身健康问题而选择不使用医疗服务的人。这些边缘患者有时会发展出边缘医疗体系，以满足他们自己所定义的需求。本文考察了加利福尼亚州阿拉米达县八个这样的边缘体系的结构和理念。在结构上，这些体系的特点在于它们的使命观念、独特的发展与演变、个性、独立性、消费者控制以及短暂的存在时间。这些体系所秉持的理念包括对健康的新定义、对适当健康促进活动的扩展定义、对客户群体的不同定义、关于分工和人员的新观念、治理和决策的新形式、对医疗保健融资的不同见解以及全新的医疗政治观念。
