Agich G J
J Med Philos. 1987 May;12(2):123-44. doi: 10.1093/jmp/12.2.123.
In this paper I analyze the alleged conflict between economic incentives to efficiently utilize health care resources and the obligation to provide patients with the best possible medical care. My analysis is developed in four stages. First, I discuss briefly the nature of prospective payment systems and economic incentives as well as the issue of professional autonomy. Second, I disscuss the notion of an incentive for action both as an economic incentive and as a concept of moral psychology. Third, I analyze several definitions of the physician's professional obligation and discuss four conditions that morally qualify the obligation. And fourth, I explore why the views of economists and physicians differ so strikingly on the question of economic incentives. In the process of this analysis, I argue that criticisms of prospective payment systems which are premised primarily on the conflict between economic incentives to contain cost and the professional obligation of beneficence are probably as much a matter of rhetoric as serious argumentation.
在本文中，我分析了有效利用医疗保健资源的经济激励措施与为患者提供尽可能最佳医疗护理的义务之间所谓的冲突。我的分析分四个阶段展开。首先，我简要讨论前瞻性支付系统和经济激励措施的性质以及专业自主权问题。其次，我将行动激励的概念既作为一种经济激励又作为一种道德心理学概念进行讨论。第三，我分析医生专业义务的几种定义，并讨论在道德上使该义务具有正当性的四个条件。第四，我探究为何经济学家和医生在经济激励问题上的观点存在如此显著的差异。在这一分析过程中，我认为主要基于控制成本的经济激励措施与行善的专业义务之间的冲突而对前瞻性支付系统提出的批评，可能更多是言辞之争而非严肃的论证。
