Lown Institute, Brookline, MA, USA.
Aragon Agency for Research and Development, Zaragoza, Spain; Aragon Health Sciences Institute, Aragon, Spain.
Lancet. 2017 Jul 8;390(10090):178-190. doi: 10.1016/S0140-6736(16)30947-3. Epub 2017 Jan 9.
The global ubiquity of overuse and underuse of health-care resources and the gravity of resulting harms necessitate an investigation of drivers to inform potential solutions. We describe the network of influences that contribute to poor care and suggest that it is driven by factors that fall into three domains: money and finance; knowledge, bias, and uncertainty; and power and human relationships. In each domain the drivers operate at the global, national, regional, and individual level, and are modulated by the specific contexts within which they act. We discuss in detail drivers of poor care in each domain.
全球范围内医疗资源的过度使用和不足使用普遍存在，由此产生的危害也十分严重，因此有必要对其驱动因素进行调查，以寻找潜在的解决方案。我们描述了导致不良医疗的影响网络，并指出其是由以下三个领域的因素驱动的：金钱和财务、知识、偏见和不确定性，以及权力和人际关系。在每个领域中，驱动因素都在全球、国家、地区和个人层面上运作，并受到其作用的具体背景的调节。我们详细讨论了每个领域中导致不良医疗的驱动因素。
