Schmidt Harald
LSE Health, LSE, Houghton Street, London, UK.
J Med Philos. 2008 Jun;33(3):198-220. doi: 10.1093/jmp/jhn007.
Bonuses, as incentives or rewards for health-related behavior, feature prominently in German social health insurance. Their goal is centered around promoting personal responsibility, but reducing overall health-care expenditure and enabling competition between sickness funds also play a role. The central position of personal responsibility in German health-care policy is described, and a framework is offered for an analysis of the ethical issues raised by policies seeking to promote responsibility. The framework entails seven tests relating to: solidarity; equality and equity; intrusiveness; attributability and opportunity of choice; evidence, rationale, and feasibility; affected third parties; and coherence. It is contended that a focus on tests, in particular from within contractualism, is the most appropriate way of addressing the question of health responsibility in pluralistic societies. However, taken by themselves, the tests also allow an identification of the key ethical issues by particular policies, which are illustrated by applying the framework to particular bonus polices.
奖金作为对与健康相关行为的激励或奖励，在德国社会医疗保险中占据显著地位。其目标主要围绕促进个人责任，但降低总体医疗保健支出以及促使疾病基金之间展开竞争也发挥着作用。文中描述了个人责任在德国医疗保健政策中的核心地位，并提供了一个框架，用于分析旨在促进责任的政策所引发的伦理问题。该框架包含与以下方面相关的七项检验：团结；平等与公平；侵扰性；可归因性与选择机会；证据、理由及可行性；受影响的第三方；以及连贯性。有人认为，专注于检验，尤其是契约主义内部的检验，是在多元社会中解决健康责任问题的最恰当方式。然而，这些检验本身也能识别特定政策的关键伦理问题，通过将该框架应用于特定奖金政策对此进行了说明。
