Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany.
BMC Health Serv Res. 2024 Oct 5;24(1):1189. doi: 10.1186/s12913-024-11624-6.
In the last decades all health systems have experienced a lack of resources. Against this background, the idea of applying personal responsibility of the patient as a criterion for allocation of resources (PRCAR) is gaining increasing attention. Bulgarian healthcare reform has been marked by the implementation of many new strategies, that grounded our scientific interest towards investigating PRCAR in Bulgarian public health law and social legislation.
Through a search of national legal databases 7 documents were selected and subjected to content analysis.
Prospective responsibility was found in two and retrospective responsibility - in three documents, two of which imposed explicit penalties on the patient. Two documents did not distinguish between the types of patient responsibility. PRCAR was found to be controversial through the prism of the social justice principle. The discussion was conducted through the perspectives of evidence translation of research to law, particularities of social cohesion in Bulgaria, and the interpretation of principles of public health ethics.
Although PRCAR was traceable in Bulgarian legislation, no supporting arguments for its introduction were deduced. The applicability of PRCAR should be further studied and wider public debate should be initiated.
在过去几十年中,所有的卫生系统都经历了资源短缺的问题。在这种背景下,将患者的个人责任作为资源分配标准(PRCAR)的理念越来越受到关注。保加利亚的医疗改革实施了许多新策略,这引起了我们对保加利亚公共卫生法和社会立法中 PRCAR 的兴趣。
通过对国家法律数据库的搜索,选择了 7 份文件,并对其进行了内容分析。
在两份文件中发现了前瞻性责任,在三份文件中发现了回溯性责任,其中两份文件对患者施加了明确的惩罚。两份文件没有区分患者责任的类型。通过社会正义原则的视角,可以发现 PRCAR 存在争议。讨论是通过研究向法律的证据转化、保加利亚社会凝聚力的特殊性以及公共卫生伦理原则的解释等方面进行的。
尽管在保加利亚的立法中可以追踪到 PRCAR,但没有推导出引入它的支持论据。PRCAR 的适用性应进一步研究,并应发起更广泛的公众辩论。