Health Services Management Centre, University of Birmingham, Birmingham, UK.
Int J Health Policy Manag. 2018 Apr 1;7(4):356-358. doi: 10.15171/ijhpm.2017.99.
This article builds on Mannion and Exworthy's account of the tensions between standardization and customization within health services to explore why these tensions exist. It highlights the limitations of explanations which root them in an expression of managerialism versus professionalism and suggests that each logic is embedded in a set of ontological, epistemological and moral commitments which are held in tension. At the front line of care delivery, people cannot resolve these tensions but must navigate and negotiate them. The legitimacy of a health system depends on its ability to deliver the 'best of both worlds' to citizens, offering the reassurance of sameness and the dignity of difference.
本文以曼尼恩和埃克索里的观点为基础，探讨了医疗服务中标准化和定制化之间的紧张关系存在的原因。文章强调了将这些紧张关系归因于管理主义与专业主义表现的解释的局限性，并表明每一种逻辑都根植于一套本体论、认识论和道德承诺，这些承诺相互制约。在医疗服务的第一线，人们无法解决这些紧张关系，而只能驾驭和协商这些关系。医疗体系的合法性取决于其为公民提供“两全其美”服务的能力，既提供一致性的保证，又尊重个体的差异。
