Ham C
Health Services Management Centre, University of Birmingham, Edgbaston, UK.
Br Med Bull. 1995 Oct;51(4):819-30. doi: 10.1093/oxfordjournals.bmb.a072997.
International experience shows that rationing can occur through exclusions or through the use of guidelines. Oregon has chosen to ration by excluding certain services in order to move towards universal population coverage. New Zealand has avoided exclusions and has chosen to ration through the use of guidelines. The Netherlands is pursuing both approaches. The experience of these and other countries demonstrates that rationing is inherently difficult. Choices in health care can be informed by techniques drawn from economics and other disciplines but these techniques need to be used as part of debate and discussion in the process of arriving at decisions. Experts and the public can contribute to this process and strenuous efforts need to be made to ensure participation by a representative cross-section of the population. At its root priority setting is a political process shaped by beliefs and values. Increased transparency in decision making should promote greater accountability and increased public awareness of the nature of rationing.
国际经验表明，配给可以通过排除某些服务或使用指导方针来实现。俄勒冈州选择通过排除某些服务来进行配给，以便朝着全民覆盖的方向发展。新西兰避免了排除某些服务的做法，而是选择通过使用指导方针来进行配给。荷兰则同时采用这两种方法。这些国家和其他国家的经验表明，配给本质上是困难的。医疗保健方面的选择可以借鉴经济学和其他学科的技术，但这些技术需要作为决策过程中辩论和讨论的一部分来使用。专家和公众可以为这一过程做出贡献，并且需要做出巨大努力以确保具有代表性的不同人群参与其中。从根本上说，确定优先事项是一个由信念和价值观塑造的政治过程。提高决策的透明度应促进更大的问责制，并提高公众对配给性质的认识。
