Liesching Florian, Meyer Thorsten, Raspe Heiner
Seniorprofessur für Bevölkerungsmedizin, Akademisches Zentrum für Bevölkerungsmedizin und Versorgungsforschung, Universität zu Lübeck.
Z Evid Fortbild Qual Gesundhwes. 2012;106(6):389-96. doi: 10.1016/j.zefq.2012.06.007. Epub 2012 Jun 28.
Germany's Central Ethics Committee of the Federal Chamber of Physicians (FCP) and other relevant national actors called for a public discourse on priority setting in health care. Politicians, members of a Federal Joint Committee and health insurance representatives, however, refused to promote or participate in the establishment of a public discussion. A change to that attitude only became apparent after former FCP President Hoppe's opening speech at the annual FCP assembly in Mainz in 2009. The present paper applies the Sociology of Knowledge Approach to Discourse, implemented through Qualitative Content Analysis and elements of Grounded Theory, to examine the development of the national public discourse in leading German print media. It creates a matrix that represents the discourse development between May 2009 and May 2010 and reflects central actors, their "communicative phenomena" and their interactions. Additionally, the matrix has been extended to cover the period until December 2011. Hoppe's arguments for priority setting in health care are faced with a wide opposition assuming opposing prerequisites and thus demanding alternative remedies. The lack of interaction between the different parties prevents any development of the speakers' positions. Incorrect accounts, reductions and left-outs in the media representation add to this effect. Consequently, the public discussion on priority setting is far from being an evolving rational discourse. Instead, it constitutes an exchange of preformed opposing positions.
德国联邦医师公会中央伦理委员会及其他相关国家行为体呼吁就医疗保健中的优先事项设定展开公开讨论。然而,政治家、联邦联合委员会成员和医疗保险代表拒绝推动或参与开展公开讨论。直到2009年联邦医师公会主席霍佩在美因茨举行的联邦医师公会年度大会上发表开幕演讲后,这种态度才有所改变。本文运用话语知识社会学方法,通过定性内容分析和扎根理论要素来研究德国主要平面媒体中全国性公开讨论的发展情况。它创建了一个矩阵,展示了2009年5月至2010年5月期间的话语发展,并反映了核心行为体、他们的“交流现象”及其互动。此外,该矩阵已扩展至涵盖截至2011年12月的时间段。霍佩关于医疗保健优先事项设定的论点面临广泛反对,这些反对意见基于相反的前提,因此要求采取替代补救措施。不同党派之间缺乏互动阻碍了发言者立场的任何发展。媒体报道中的错误描述、删减和遗漏加剧了这种影响。因此,关于优先事项设定的公开讨论远非一场不断发展的理性话语。相反,它构成了预先形成的对立立场的交流。