Caillol Michel, Le Coz Pierre, Aubry Régis, Bréchat Pierre-Henri
Chirurgien orthopédiste et traumatologue, hôpital Ambroise Paré, 1, rue d'Eylau, 13291 Marseille, France.
Sante Publique. 2010 Nov-Dec;22(6):625-36.
Health system and hospital reforms have led to important and on-going legislative, structural and organizational changes. Is there any logic at work within the health system and hospitals that could call into question the principle of solidarity, the secular values of ethics that govern the texts of law and ethics? In order to respond, we compared our experiences to a review of the professional and scientific literature from 1992 to 2010. Over the course of the past eighteen years, health system organization was subjected to variations and significant tensions. These variations are witnesses to a paradigm shift: although a step towards the regionalization of the health system integrating the choice of public health priorities, consultation and participatory democracy has been implemented, nevertheless the system was then re-oriented towards the trend of returning to centralization on the basis of uniting economics, technical modernization and contracting. This change of doctrine may undermine the social mission of hospitals and the principle of solidarity. Progress, the aging population and financial constraints would force policy-makers to steer the health system towards more centralized control. Hospitals, health professionals and users may feel torn within a system that tends to simplify and minimize what is becoming increasingly complex and global. Benchmarks on values, ethics and law for the hospitals, healthcare professionals and users are questioned. These are important elements to consider when the law on the reform of hospitals, patients, health care and territories and regional health agencies is implemented.
卫生系统和医院改革已带来了重要且持续的立法、结构和组织变革。在卫生系统和医院内部，是否存在某种逻辑，可能会对团结原则以及作为法律和伦理文本基础的世俗伦理价值观提出质疑？为了回答这一问题，我们将自身经验与对1992年至2010年专业和科学文献的综述进行了比较。在过去的十八年里，卫生系统组织经历了种种变化和巨大压力。这些变化见证了一种范式转变：尽管朝着整合公共卫生优先事项选择、协商和参与式民主的卫生系统区域化迈出了一步，但随后该系统又重新转向基于经济整合、技术现代化和合同制的集权化趋势。这种学说的转变可能会损害医院的社会使命和团结原则。进步、人口老龄化和财政限制将迫使政策制定者将卫生系统导向更集中的控制。在一个趋于简化并尽量减少日益复杂和全球化事务的系统中，医院、卫生专业人员和用户可能会感到无所适从。医院、医疗保健专业人员和用户在价值观、伦理和法律方面的基准受到质疑。在实施关于医院、患者、医疗保健和地区以及区域卫生机构改革的法律时，这些都是需要考虑的重要因素。
