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健康、患病与责任:公共医疗体系中对健康责任的态度

Being Healthy, Being Sick, Being Responsible: Attitudes towards Responsibility for Health in a Public Healthcare System.

作者信息

Traina Gloria, Martinussen Pål E, Feiring Eli

机构信息

Department of Health Management and Health Economics, University of Oslo.

Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU).

出版信息

Public Health Ethics. 2019 Jun 24;12(2):145-157. doi: 10.1093/phe/phz009. eCollection 2019 Jul.

Abstract

Lifestyle-induced diseases are becoming a burden on healthcare, actualizing the discussion on health responsibilities. Using data from the National Association for Heart and Lung Diseases (LHL)'s 2015 Health Survey ( = 2689), this study examined the public's attitudes towards personal and social health responsibility in a Norwegian population. The questionnaires covered self-reported health and lifestyle, attitudes towards personal responsibility and the authorities' responsibility for promoting health, resource-prioritisation and socio-demographic characteristics. Block-wise multiple linear regression assessed the association between attitudes towards health responsibilities and individual lifestyle, political orientation and health condition. We found a moderate support for social responsibility across political views. Respondents reporting unhealthier eating habits, smokers and physically inactive were less supportive of health promotion policies (including information, health incentives, prevention and regulations). The idea that individuals are responsible for taking care of their health was widely accepted as an abstract ideal. Yet, only a third of the respondents agreed with introducing higher co-payments for treatment of 'self-inflicted' conditions and levels of support were patterned by health-related behaviour and left-right political orientation. Our study suggests that a significant support for social responsibility does not exclude a strong support for personal health responsibility. However, conditional access to healthcare based on personal lifestyle is still controversial.

摘要

生活方式引发的疾病正成为医疗保健的负担,促使人们对健康责任展开讨论。本研究利用美国国家心肺疾病协会(LHL)2015年健康调查(n = 2689)的数据,考察了挪威民众对个人和社会健康责任的态度。问卷涵盖了自我报告的健康状况和生活方式、对个人责任的态度以及当局在促进健康方面的责任、资源优先排序和社会人口特征。分块多元线性回归分析评估了对健康责任的态度与个人生活方式、政治倾向和健康状况之间的关联。我们发现,不同政治观点对社会责任都有一定程度的支持。报告饮食习惯不健康、吸烟以及缺乏体育锻炼的受访者对健康促进政策(包括信息、健康激励、预防和监管)的支持度较低。个人应对自身健康负责这一观念作为一种抽象理念得到广泛认可。然而,只有三分之一的受访者同意对“自我造成”的疾病治疗引入更高的自付费用,支持程度因与健康相关的行为以及左右政治倾向而异。我们的研究表明,对社会责任的大力支持并不排除对个人健康责任的强烈支持。然而,基于个人生活方式有条件地获得医疗保健仍然存在争议。

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