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程序公平以重新校准健康决策中的权力失衡:对报告《公开与包容:全民健康覆盖融资的公平程序》的评论

Procedural fairness to recalibrate the power imbalance in health decision-making: comment on the report: 'Open and inclusive: Fair processes for financing universal health coverage'.

作者信息

Rajan Dheepa, Rouffy-Ly Benjamin

机构信息

European Observatory on Health Systems and Policies, Brussels, Belgium.

World Health Organization, Geneva, Switzerland.

出版信息

Health Econ Policy Law. 2025 Jan;20(1):19-25. doi: 10.1017/S1744133124000197. Epub 2024 Oct 21.

DOI:10.1017/S1744133124000197
PMID:39431353
Abstract

The policy-making process for health financing in most places lacks equity, failing to adequately consider the voices of ordinary citizens, residents, and especially those facing significant disadvantage. Procedural fairness is about addressing this imbalance, which requires a recalibration of power dynamics, ensuring that decision-making incorporates a more diverse range of perspectives. In this comment, we highlight the important contributions made by the report 'Open and inclusive: Fair processes for financing universal health coverage' in furthering the understanding and importance of procedural fairness in health financing decision-making especially as it relates to the three sub-functions of financing - revenue raising, pooling, and purchasing. We also argue for the importance of conceptual clarity - especially as to the added value of procedural fairness vis-à-vis accountability - and critically review the proposed framework for procedural fairness, emphasising the role of voice as the linchpin to advancing equity in influence.

摘要

大多数地方的卫生筹资决策过程缺乏公平性,没有充分考虑普通公民、居民尤其是那些处于严重不利地位者的声音。程序公平旨在解决这种失衡问题,这需要重新调整权力动态,确保决策纳入更多样化的观点。在本评论中,我们强调《开放与包容:全民健康覆盖筹资的公平程序》报告在促进对卫生筹资决策中程序公平的理解及其重要性方面所做的重要贡献,特别是在涉及筹资的三个子功能——筹资、风险共担和采购时。我们还主张概念清晰的重要性——尤其是程序公平相对于问责制的附加值——并批判性地审视提议的程序公平框架,强调声音作为推进影响力公平的关键作用。

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