Saltman R B
Division of Health Policy and Management, Emory University School of Public Health, Atlanta, GA 30329.
Int J Health Serv. 1994;24(2):201-29. doi: 10.2190/8WMP-RR2K-ABM7-NVNH.
The issue of patient choice presents a complicated challenge to publicly operated health systems. Increased patient choice can strengthen the citizen's commitment to traditional welfare state objectives, or alternatively, it can severely damage that commitment, depending upon the design of the choice mechanism and the structural context within which patient choice occurs. For patient choice to be linked to true empowerment, choice must reinforce rather than undercut the accountability of health care providers to the population they serve. This article explores the basic issues involved in empowering patients within publicly operated health systems. The author first reviews the conceptual components that could or should be incorporated within the notion of empowered patients, then examines what would be required to actually empower patients within health systems, defined in terms of expanding not only logistical choice but also clinical influence and decision-making participation. The article concludes with a wide-ranging analysis of the impact of potential policies and mechanisms on the long-term objectives in achieving democratically accountable health care systems.
患者选择问题给公立医疗系统带来了复杂的挑战。患者选择的增加既能强化公民对传统福利国家目标的承诺，也可能严重损害这种承诺，这取决于选择机制的设计以及患者选择发生的结构背景。要使患者选择与真正的赋权相联系，选择必须加强而非削弱医疗服务提供者对其服务人群的问责制。本文探讨了在公立医疗系统中赋予患者权力所涉及的基本问题。作者首先回顾了可能或应该纳入赋权患者概念的组成部分，然后研究了在医疗系统中真正赋予患者权力需要什么，这不仅包括扩大后勤选择，还包括临床影响力和决策参与度。文章最后对潜在政策和机制对实现民主问责医疗系统长期目标的影响进行了广泛分析。
