Giacomini Mita, Hurley Jeremiah, Gold Irving, Smith Patricia, Abelson Julia
Centre for Health Economics and Policy Analysis, McMaster University, HSC-3H1C, Hamilton, ON, Canada L8N 3Z5.
Health Policy. 2004 Jan;67(1):15-24. doi: 10.1016/s0168-8510(03)00100-3.
Despite widespread recognition of the importance of values, decision makers and stakeholders in health policy appear to disagree fundamentally over what 'values' essentially are. Hidden dissent about the nature of values can confuse policy deliberations. This study investigates empirically the following two questions: (1) what sorts of entities do Canadian health reformers typically call 'values'? and; (2) how do Canadian health reformers use the idea of values in health reform rhetoric? We conducted a qualitative, interpretive analysis of 36 Canadian health reform documents published during the period 1990-1999. The values raised in Canadian health reform rhetoric vary widely not only in topic (e.g. health states, health services, equity, economic viability, etc.) but also in substance (e.g. physical entities, goals, principles, attitudes, etc.). We review the diversity of concepts underlying 'values talk' in health policy, and discuss implications for policy analysis and future research.
尽管人们普遍认识到价值观的重要性，但卫生政策中的决策者和利益相关者似乎在“价值观”的本质究竟是什么这一问题上存在根本分歧。关于价值观本质的隐性分歧可能会使政策审议变得混乱。本研究通过实证调查以下两个问题：（1）加拿大卫生改革者通常将哪些类型的实体称为“价值观”？以及；（2）加拿大卫生改革者如何在卫生改革言论中运用价值观的概念？我们对1990年至1999年期间发表的36份加拿大卫生改革文件进行了定性的、解释性分析。加拿大卫生改革言论中提出的价值观不仅在主题（如健康状态、卫生服务、公平、经济可行性等）上差异很大，而且在实质内容（如物质实体、目标、原则、态度等）上也有很大不同。我们审视了卫生政策中“价值观话语”背后概念的多样性，并讨论了其对政策分析和未来研究的影响。
