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“自由优先”与双层医疗体系的设计

"Priority of liberty" and the design of a two-tier health care system.

作者信息

Breyer Friedrich, Kliemt Hartmut

机构信息

University of Konstanz, Konstanz, Germany Frankfurt School of Finance & Management, Frankfurt, Germany.

University of Konstanz, Konstanz, Germany Frankfurt School of Finance & Management, Frankfurt, Germany

出版信息

J Med Philos. 2015 Apr;40(2):137-51. doi: 10.1093/jmp/jhu076. Epub 2015 Feb 10.

Abstract

Libertarian views on rights tend to rule out coercive redistribution for purposes of public health care guarantees, whereas liberal conceptions support coercive funding of potentially unlimited access to medical services in the name of medical needs. Taking the "priority of liberty" seriously as supreme political value, a plausible prudential argument can avoid these extremes by providing systematic reasons for both delivering and limiting publicly financed guarantees. Given impending demographic change and rapid technical progress in medicine, only a two-tier system with explicitly limited public guarantees and optional privately financed health services seems acceptable.

摘要

自由意志主义者对权利的看法往往排除为了公共医疗保障目的而进行的强制性再分配,而自由主义观念则支持以医疗需求之名对潜在的无限制医疗服务获取进行强制性资金筹集。将“自由优先”作为至高无上的政治价值认真对待,一个合理的审慎论证可以通过为提供和限制公共资助保障提供系统性理由来避免这些极端情况。鉴于即将到来的人口结构变化和医学领域的快速技术进步,只有一个具有明确有限公共保障和可选私人资助医疗服务的双层体系似乎是可接受的。

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