Institute of Health Policy and Management, College of Public Health, National Taiwan University, 17 Xu-Zhou Road, Taipei, Taiwan.
Med Health Care Philos. 2022 Sep;25(3):531-539. doi: 10.1007/s11019-022-10098-9. Epub 2022 Jun 13.
As the assumptions of perpetual economic and population growth no longer stand, the welfare systems built on such promises are in peril. Policymakers must reallocate the responsibility for providing care between generations. Democratic theories can help establish procedures for finding solutions, particularly in ageing democratic countries. By analysing existing representative and deliberative democratic theories, this paper explores how the interests of future generations could be included in such procedures. A hypothetical social health insurance scheme with the pay-as-you-go financial arrangement is selected as an illustrative case. This paper argues that due to the intrinsic bias towards the current generation, both representative and deliberative democratic health policymaking are limited in making decisions that account for future generations. Instead, their interests could be at best represented by benevolent representatives.
随着经济和人口持续增长的假设不再成立，建立在这些承诺基础上的福利体系正处于危险之中。政策制定者必须在代际之间重新分配提供护理的责任。民主理论可以帮助确定寻找解决方案的程序，特别是在老龄化的民主国家。本文通过分析现有的代表性和审议性民主理论，探讨了如何将后代的利益纳入这些程序。选择具有现收现付财务安排的假设社会健康保险计划作为说明性案例。本文认为，由于对当前一代的固有偏见，代表性和审议性民主的卫生决策制定在考虑到后代的利益方面存在局限性。相反，他们的利益最多只能由仁慈的代表来代表。
