Hadorn D C
Department of Social Policy, RAND, Santa Monica, Calif 90407-2138.
JAMA. 1992 Sep 16;268(11):1454-9.
Increasingly stringent fiscal restrictions on the scope of medical services available to patients have resulted in calls for explicit health care priority setting. Several commentators have called for the application of decision-analytic principles to such efforts, which would assign services priority based on the extent to which they produce preferred health outcomes. The Oregon Medicaid exercise is an example of such a process. An important challenge to these utilitarian efforts is the need to avoid discrimination against people with medical disabilities. Both of the key elements entailed by decision-analytic approaches to priority setting--estimation of outcomes and assignment of values to those outcomes--are vulnerable to charges of discrimination, primarily because both the medical outcomes expected in disabled individuals and the values they place on those outcomes may differ from the general public. Priority-setting efforts must proceed carefully to avoid the appearance (and reality) of discrimination.
对患者可获得的医疗服务范围日益严格的财政限制导致了对明确的医疗保健优先事项设定的呼吁。几位评论家呼吁将决策分析原则应用于此类工作，即根据服务产生理想健康结果的程度来确定其优先级。俄勒冈医疗补助计划就是这样一个过程的例子。这些功利主义努力面临的一个重要挑战是需要避免对身患残疾的人产生歧视。决策分析方法进行优先事项设定所涉及的两个关键要素——结果评估和对这些结果的价值赋予——都容易受到歧视指控，主要是因为残疾个体预期的医疗结果以及他们对这些结果所赋予的价值可能与普通大众不同。设定优先事项的工作必须谨慎进行，以避免出现（以及实际存在）歧视。
