Culyer A J
Department of Economics and Related Studies, University of York, England.
Health Econ. 1992 Apr;1(1):7-18. doi: 10.1002/hec.4730010105.
There are some general considerations which have implications for the delivery and finance of health care in all countries, not only Canada and the USA. Beginning with two propositions: that access to health care is a right of citizenship, which should not depend on individual income and wealth; and that the objective of health services is to maximise the impact on the nation's health of the resources available; the paper examines the ethical justification for pursuing efficiency in health care provision. The different meanings of efficiency are discussed in detail, and the use of quantitative indicators of health benefit, such as the QALY, placed in context. It is argued that the determination of health care resource allocations should take account of costs at both the macro planning level and the micro level of the individual doctor-patient relationship. Given the starting points the overall conclusion is that it is ethical to be efficient, since to be inefficient implies failure to achieve the ethical objective of maximising health benefits from available resources.
有一些普遍的考量因素对所有国家的医疗保健提供和融资都有影响，而不仅仅是加拿大和美国。从两个命题开始：获得医疗保健是公民的一项权利，不应取决于个人收入和财富；医疗服务的目标是使可用资源对国家健康的影响最大化。本文探讨了在医疗保健提供中追求效率的伦理依据。详细讨论了效率的不同含义，并将健康效益的定量指标（如质量调整生命年）的使用置于背景之中。有人认为，医疗保健资源分配的确定应在宏观规划层面和个体医患关系的微观层面都考虑成本。鉴于这些出发点，总体结论是提高效率是符合伦理的，因为效率低下意味着未能实现从可用资源中最大化健康效益这一伦理目标。
