Persaud R D
Bethlem Royal Hospital, London.
J Med Ethics. 1991 Mar;17(1):10-8. doi: 10.1136/jme.17.1.10.
The British Government is implementing some major alterations to the way health services in Great Britain are organised. As well as the introduction of competition between health care providers, their financial interests are to be linked to their output, in efforts to use market forces to increase efficiency and cut costs. This paper looks at the possible impact of these changes of health care organisation on ethical medical practice. This is investigated with particular reference to the country whose health service has embraced most closely these elements of the market--the United States of America. The question to be answered is whether high standards of ethical care are ensured by factors somehow intrinsic to the medical profession, and are therefore immune to changes in the economics of health care. This assumption is shown to be questionable in light of what is known about the determinants of ethical medical practice.
英国政府正在对英国医疗服务的组织方式进行一些重大变革。除了在医疗服务提供者之间引入竞争外，还将把他们的经济利益与产出挂钩，以努力利用市场力量提高效率并削减成本。本文探讨了这些医疗服务组织变革对符合伦理的医疗实践可能产生的影响。特别参考了医疗服务最紧密采纳这些市场要素的国家——美利坚合众国对此进行研究。要回答的问题是，符合伦理的医疗高标准是否由医疗行业内在的某些因素所确保，因此不受医疗保健经济变化的影响。鉴于已知的符合伦理的医疗实践的决定因素，这一假设被证明是有问题的。
