Health Economics Unit, University of Cape Town, Observatory, South Africa.
Health Policy Plan. 2011 Nov;26(6):464-70. doi: 10.1093/heapol/czq081. Epub 2010 Dec 24.
Trying to determine how best to allocate resources in health care is especially difficult when resources are severely constrained, as is the case in all developing countries. This is particularly true in South Africa currently where the HIV epidemic adds significantly to a health service already overstretched by the demands made upon it. This paper proposes a framework for determining how best to allocate scarce health care resources in such circumstances. This is based on communitarian claims. The basis of possible claims considered include: the need for health care, specified both as illness and capacity to benefit; whether or not claimants have personal responsibility in the conditions that have generated their health care need; relative deprivation or disadvantage; and the impact of services on the health of society and on the social fabric. Ways of determining these different claims in practice and the weights to be attached to them are also discussed. The implications for the treatment of HIV/AIDS in South Africa are spelt out.
在资源严重受限的情况下，例如所有发展中国家的情况，试图确定如何最好地分配医疗保健资源尤其困难。在南非，这种情况尤其如此，目前艾滋病毒的流行使得本已不堪重负的卫生服务系统雪上加霜。本文提出了一个在这种情况下确定如何最好地分配稀缺卫生保健资源的框架。这是基于社群主义的主张。所考虑的可能主张的基础包括：医疗保健的需求，既包括疾病，也包括受益能力；索赔人是否对导致其医疗保健需求的条件负有个人责任；相对剥夺或劣势；以及服务对社会健康和社会结构的影响。还讨论了在实践中确定这些不同主张的方法以及赋予它们的权重。阐述了在南非治疗艾滋病毒/艾滋病的影响。
