Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Box 564, 751 22 Uppsala, Sweden.
Health Policy. 2013 Jun;111(1):95-8. doi: 10.1016/j.healthpol.2012.12.002. Epub 2013 Jan 3.
Choice and competition reforms in healthcare often involve the idea of empowering patients through the mechanism of 'exit'. Using Swedish healthcare as an example, this article illustrates that this kind of efforts to empower patients may not only affect patients' chances of influencing healthcare but also those of citizens, who may lose 'voice' as a result. Thus, it is an example of the conflict between representative democracy and the customers' control over welfare services; a conflict that may be overcome by providing new forms of collective decision-making. This was not the case when introducing a patient choice reform in Swedish primary care in 2010.
医疗保健中的选择和竞争改革通常涉及通过“退出”机制赋予患者权力的想法。本文以瑞典的医疗保健为例，说明了这种赋予患者权力的努力不仅可能影响患者影响医疗保健的机会，还可能影响公民的机会，因为他们可能因此失去“声音”。因此，这是代议制民主与客户对福利服务的控制之间冲突的一个例子；这种冲突可以通过提供新的集体决策形式来克服。2010 年在瑞典初级保健中引入患者选择改革时，情况并非如此。
