van Exel Job, Baker Rachel, Mason Helen, Donaldson Cam, Brouwer Werner
Erasmus University Rotterdam, Institute of Health Policy and Management, Rotterdam, The Netherlands.
Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, G4 OBA, Scotland.
Soc Sci Med. 2015 Feb;126:128-37. doi: 10.1016/j.socscimed.2014.12.023. Epub 2014 Dec 22.
Resources available to the health care sector are finite and typically insufficient to fulfil all the demands for health care in the population. Decisions must be made about which treatments to provide. Relatively little is known about the views of the general public regarding the principles that should guide such decisions. We present the findings of a Q methodology study designed to elicit the shared views in the general public across ten countries regarding the appropriate principles for prioritising health care resources. In 2010, 294 respondents rank ordered a set of cards and the results of these were subject to by-person factor analysis to identify common patterns in sorting. Five distinct viewpoints were identified, (I) "Egalitarianism, entitlement and equality of access"; (II) "Severity and the magnitude of health gains"; (III) "Fair innings, young people and maximising health benefits"; (IV) "The intrinsic value of life and healthy living"; (V) "Quality of life is more important than simply staying alive". Given the plurality of views on the principles for health care priority setting, no single equity principle can be used to underpin health care priority setting. Hence, the process of decision making becomes more important, in which, arguably, these multiple perspectives in society should be somehow reflected.
医疗保健部门可用的资源是有限的，通常不足以满足人群对医疗保健的所有需求。必须决定提供哪些治疗方法。对于公众对指导此类决策的原则的看法，我们了解得相对较少。我们展示了一项Q方法研究的结果，该研究旨在引出十个国家公众对医疗保健资源优先排序适当原则的共同看法。2010年，294名受访者对一组卡片进行了排序，这些结果经过个人因素分析，以确定分类中的共同模式。确定了五个不同的观点，（I）“平等主义、权利和获得机会平等”；（II）“健康收益的严重程度和规模”；（III）“公平寿限、年轻人和最大化健康益处”；（IV）“生命的内在价值和健康生活”；（V）“生活质量比仅仅活着更重要”。鉴于在医疗保健优先排序原则上存在多种观点，没有单一的公平原则可用于支持医疗保健优先排序。因此，决策过程变得更加重要，可以说，社会中的这些多种观点应以某种方式得到体现。
