Strauss R P
School of Dentistry, University of North Carolina, Chapel Hill 27599-7450.
Cleft Palate Craniofac J. 1992 Nov;29(6):585-90; discussion 570. doi: 10.1597/1545-1569_1992_029_0585_eahpii_2.3.co_2.
The advent of craniofacial surgery and neonatal intensive care has made it possible for children with serious craniofacial deformities to live and possibly to experience effective habilitation. These therapeutic innovations also raise important social and ethical issues that are rarely examined. This paper reviews the dilemmas that relate to the gatekeeper role for physicians, the impact of prenatal diagnosis, and the allocation of scarce fiscal and health resources to craniofacial care. The high degree of cost, the intense investment of medical resources, and the uncertain outcomes in the care of children with major craniofacial deformities, must be considered in the distribution of resources within a health system. The rationing of health resources is discussed as a future determinant of how care for major craniofacial deformities may be delivered in the United States.
颅面外科手术和新生儿重症监护的出现，使患有严重颅面畸形的儿童能够存活下来，并有可能获得有效的康复治疗。这些治疗创新也引发了一些重要的社会和伦理问题，而这些问题很少受到审视。本文回顾了与医生把关人角色、产前诊断的影响以及为颅面护理分配稀缺财政和卫生资源相关的困境。在卫生系统内分配资源时，必须考虑到治疗患有严重颅面畸形儿童的高成本、医疗资源的大量投入以及不确定的治疗结果。作为未来美国如何提供主要颅面畸形护理的一个决定因素，卫生资源的配给问题也在本文中进行了讨论。
