Alvarez Allen Andrew A
Department of Philosophy, University of the Philippines Diliman, Quezon City, Philippines.
Bioethics. 2007 Oct;21(8):426-38. doi: 10.1111/j.1467-8519.2007.00580.x.
Application of egalitarian and prioritarian accounts of health resource allocation in low-income countries have both been criticized for implying distribution outcomes that allow decreasing/undermining health gains and for tolerating unacceptable standards of health care and health status that result from such allocation schemes. Insufficient health care and severe deprivation of health resources are difficult to accept even when justified by aggregative efficiency or legitimized by fair deliberative process in pursuing equality and priority oriented outcomes. I affirm the sufficientarian argument that, given extreme scarcity of public health resources in low-income countries, neither health status equality between populations nor priority for the worse off is normatively adequate. Nevertheless, the threshold norm alone need not be the sole consideration when a country's total health budget is extremely scarce. Threshold considerations are necessary in developing a theory of fair distribution of health resources that is sensitive to the lexically prior norm of sufficiency. Based on the intuition that shares must not be taken away from those who barely achieve a minimal level of health, I argue that assessments based on standards of minimal physical/mental health must be developed to evaluate the sufficiency of the total resources of health systems in low-income countries prior to pursuing equality, priority, and efficiency based resource allocation. I also begin to examine how threshold sensitive health resource assessment could be used in the Philippines.
在低收入国家应用平等主义和优先主义的卫生资源分配原则，都受到了批评，原因在于这两种原则所暗示的分配结果会导致健康收益的减少或受损，以及容忍由这种分配方案所产生的不可接受的医疗保健和健康状况标准。即使以总体效率为理由或通过追求平等和优先导向结果的公平审议过程使其合法化，医疗保健不足和卫生资源严重匮乏也是难以接受的。我认同充足主义的观点，即在低收入国家公共卫生资源极度稀缺的情况下，无论是人群之间的健康状况平等，还是对处境较差者的优先考虑，在规范上都是不充分的。然而，当一个国家的卫生总预算极其稀缺时，仅阈值规范不一定是唯一的考虑因素。在发展一种对词汇优先的充足性规范敏感的卫生资源公平分配理论时，阈值考量是必要的。基于不能从那些勉强达到最低健康水平的人那里拿走份额的直觉，我认为必须制定基于最低身心健康标准的评估方法，以便在追求基于平等、优先和效率的资源分配之前，评估低收入国家卫生系统的总资源是否充足。我还开始研究阈值敏感的卫生资源评估如何能在菲律宾得到应用。
