Mariner W K
Boston University School of Public Health, MA 02118-2394, USA.
Am J Public Health. 1995 Oct;85(10):1439-45. doi: 10.2105/ajph.85.10.1439.
With adequate cost containment unlikely in the foreseeable future, health care use will have to be curtailed, ideally with open and explicit criteria for equitably allocating resources or rationing. Yet, consensus on any such criteria appears remote because Americans cannot say no to health care. Americans may refuse to accept rationing for two reasons. The absence of any global limitation on health care resources may encourage patients to believe that health care resources are not scarce and do not need to be rationed. A belief in vitalism--that everyone is morally entitled to unlimited longevity and good health--may discourage setting limits on one's own care. Together, these characteristics may foster the belief that denials of health care services, especially by health insurers, are arbitrary or unfair refusals to pay for existing resources and not a necessary method of rationing scarce resources. If this hypothesis is true, Americans are unlikely to achieve consensus on any equitable allocation of health care unless they face an actual shortage (credible scarcity) of health care resources that makes it necessary to ration care.
在可预见的未来不太可能实现充分的成本控制，因此必须削减医疗保健的使用，理想的做法是制定公开明确的标准来公平分配资源或进行配给。然而，就任何此类标准达成共识似乎遥不可及，因为美国人无法拒绝医疗保健。美国人可能出于两个原因拒绝接受配给。对医疗保健资源缺乏任何全球限制可能会促使患者认为医疗保健资源并不稀缺，无需进行配给。对活力论的信仰——即每个人在道德上都有权享有无限的长寿和健康——可能会阻碍对自己的医疗保健设置限制。这些特征共同作用，可能会助长这样一种信念，即拒绝提供医疗保健服务，尤其是保险公司的拒绝，是任意或不公平地拒绝为现有资源付费，而不是配给稀缺资源的必要方法。如果这一假设成立，美国人不太可能就医疗保健的任何公平分配达成共识，除非他们面临医疗保健资源的实际短缺（可信的稀缺），从而有必要对医疗保健进行配给。
