Williams A
Centre for Health Economics, University of York, UK.
Health Econ. 1997 Mar-Apr;6(2):117-32. doi: 10.1002/(sici)1099-1050(199703)6:2<117::aid-hec256>3.0.co;2-b.
Many different equity principles may need to be traded off against efficiency when prioritizing health care. This paper explores one of them: the concept of a 'fair innings'. It reflects the feeling that everyone is entitled to some 'normal' span of health (usually expressed in life years, e.g. 'three score years and ten') and anyone failing to achieve this has been cheated, whilst anyone getting more than this is 'living on borrowed time'. Four important characteristics of the 'fair innings' notion are worth noting: firstly, it is outcome based, not process-based or resource-based; secondly, it is about a person's whole life-time experience, not about their state at any particular point in time; thirdly, it reflects an aversion to inequality; and fourthly, it is quantifiable. Even in common parlance it is usually expressed in numerical terms: death at 25 is viewed very differently from death at 85. But age at death should be no more than a first approximation, because the quality of a person's life is important as well as its length. The analysis suggests that this notion of intergenerational equity requires greater discrimination against the elderly than would be dictated simply by efficiency objectives.
在确定医疗保健的优先次序时，许多不同的公平原则可能需要与效率相互权衡。本文探讨其中之一：“公平寿限”的概念。它反映了这样一种观念，即每个人都有权享有一定的“正常”健康跨度（通常以寿命年数表示，例如“七十岁”），任何未能达到这一标准的人都受到了欺骗，而任何超过这一标准的人则是“在透支时间生活”。“公平寿限”概念的四个重要特征值得注意：首先，它基于结果，而非基于过程或资源；其次，它关乎一个人的一生经历，而非其在任何特定时间点的状态；第三，它体现了对不平等的厌恶；第四，它是可量化的。即使在日常用语中，它通常也用数字来表达：25岁死亡与85岁死亡的看法截然不同。但死亡年龄不应只是一个初步近似值，因为一个人的生活质量与其寿命长度同样重要。分析表明，这种代际公平的概念要求对老年人进行比单纯效率目标所要求的更大程度的区别对待。
