Porzsolt F, Weiss M, Hege-Scheuing G, Fangerau H
Klinische Ökonomik, Universität Ulm, Ulm, Germany.
Dtsch Med Wochenschr. 2010 Nov;135(45):2257-62. doi: 10.1055/s-0030-1267509. Epub 2010 Nov 2.
Clinical economics requires an understanding of clinical relationships just like health economy requires an understanding of economic relationships. Hitherto we have ensured that economists can differentiate symptoms from diagnoses and diagnostics from screening at the interface between medicine and economy. However, we overlooked the fact that physicians should be able to understand the principles of marginal benefit and medical ethics, as well as the differences among efficacy, effectiveness, and benefit, to be able to make sound decisions. To make up for this neglected demand, we present our definition of clinical economics, identify the potential conflicts between medical professionalism and commercialized medicine, describe the importance - but also the limits - of scientific evidence, explain the difference between 'prioritization' and strict rationing, and attempt to justify the fact that the necessary changes in the provision of healthcare will probably only be achieved if we instill this new way of thinking in medical students during their medical education. Complementing the medical curriculum with clinical economics would achieve this goal.
临床经济学需要理解临床关系，正如卫生经济学需要理解经济关系一样。迄今为止，我们已确保经济学家能够在医学与经济的交叉点上区分症状与诊断、诊断与筛查。然而，我们忽略了一个事实，即医生应该能够理解边际效益和医学伦理原则，以及疗效、有效性和效益之间的差异，以便能够做出明智的决策。为了弥补这一被忽视的需求，我们给出了临床经济学的定义，识别医学专业性与商业化医疗之间的潜在冲突，描述科学证据的重要性——以及局限性——解释“优先排序”与严格配给之间的差异，并试图说明只有在医学教育期间向医学生灌输这种新的思维方式，医疗保健供应方面的必要变革才可能实现这一事实。用临床经济学补充医学课程将实现这一目标。
