Fredriksson Mio, Tritter Jonathan Q
Department of Public Health and Caring Sciences, Uppsala University, Sweden.
School of Languages and Social Sciences, Aston University, UK.
Sociol Health Illn. 2017 Jan;39(1):95-111. doi: 10.1111/1467-9566.12483. Epub 2016 Nov 11.
Patient and public involvement has become an integral aspect of many developed health systems and is judged to be an essential driver for reform. However, little attention has been paid to the distinctions between patients and the public, and the views of patients are often seen to encompass those of the general public. Using an ideal-type approach, we analyse crucial distinctions between patient involvement and public involvement using examples from Sweden and England. We highlight that patients have sectional interests as health service users in contrast to citizens who engage as a public policy agent reflecting societal interests. Patients draw on experiential knowledge and focus on output legitimacy and performance accountability, aim at typical representativeness, and a direct responsiveness to individual needs and preferences. In contrast, the public contributes with collective perspectives generated from diversity, centres on input legitimacy achieved through statistical representativeness, democratic accountability and indirect responsiveness to general citizen preferences. Thus, using patients as proxies for the public fails to achieve intended goals and benefits of involvement. We conclude that understanding and measuring the impact of patient and public involvement can only develop with the application of a clearer comprehension of the differences.
患者及公众参与已成为许多发达卫生系统不可或缺的一部分，并被视为改革的关键驱动力。然而，人们很少关注患者与公众之间的差异，患者的观点往往被视为涵盖了普通公众的观点。我们运用理想类型法，以瑞典和英国的实例分析患者参与和公众参与之间的关键差异。我们强调，与作为反映社会利益的公共政策主体参与的公民不同，患者作为卫生服务使用者有局部利益。患者利用经验知识，关注产出合法性和绩效问责制，追求典型代表性，并直接回应个人需求和偏好。相比之下，公众贡献源于多样性的集体观点，以通过统计代表性、民主问责制和对普通公民偏好的间接回应实现的输入合法性为核心。因此，将患者用作公众的替代无法实现参与的预期目标和益处。我们得出结论，只有更清晰地理解这些差异，才能更好地理解和衡量患者及公众参与的影响。
