Anand Paul
Economics Discipline, Faculty of Social Sciences, The Open University, Walton Hall, Milton Keynes MK7 6AA, UK.
J Health Econ. 2003 Sep;22(5):731-45. doi: 10.1016/S0167-6296(03)00024-9.
The paper contributes to the use of social choice and welfare theory in health economics by developing and applying the integration of claims framework to health-care rationing. Related to Sen's critique of neo-classical welfare economics, the integration of claims framework recognises three primitive sources of claim: consequences, deontology and procedures. A taxonomy is presented with the aid of which it is shown that social welfare functions reflecting these claims individually or together, can be specified. Some of the resulting social choice rules can be regarded as generalisations of health-maximisation and all have normative justifications, though the justifications may not be universally acceptable. The paper shows how non-linear programming can be used to operationalise such choice rules and illustrates their differential impacts on the optimal provision of health-care. Following discussion of relations to the capabilities framework and the context in which rationing occurs, the paper concludes that the integration of claims provides a viable framework for modelling health-care rationing that is technically rigorous, general and tractable, as well as being consistent with relevant moral considerations and citizen preferences.
本文通过开发并应用权利主张整合框架于医疗保健配给，为社会选择和福利理论在健康经济学中的应用做出了贡献。与森对新古典福利经济学的批判相关，权利主张整合框架认识到权利主张的三个原始来源：结果、道义论和程序。本文提出了一种分类法，借助该分类法表明，可以指定分别或共同反映这些权利主张的社会福利函数。由此产生的一些社会选择规则可被视为健康最大化的推广，并且都有规范依据，尽管这些依据可能并非普遍可接受。本文展示了如何使用非线性规划来实施此类选择规则，并说明了它们对医疗保健最优提供的不同影响。在讨论了与能力框架的关系以及配给发生的背景之后，本文得出结论，权利主张的整合为医疗保健配给建模提供了一个可行的框架，该框架在技术上严谨、通用且易于处理，同时也符合相关的道德考量和公民偏好。
