Wilkes M, Coulter I, Hurwitz E
Center for Education Research and Development, School of Medicine, University of California, Los Angeles 90095-1736, USA.
Soc Sci Med. 1998 Oct;47(8):1043-9. doi: 10.1016/s0277-9536(98)00172-5.
An unanswered question in previous research on attitudes to health care systems is whether the values held by medical students are unique to them or simply a cohort phenomenon. This study addresses this by measuring values and attitudes on entry to medical school, and comparing them with two other groups whose academic standing at entry and social status are likely to be comparable business and law students. In this paper four substantive areas are dealt with: managed care, cost controls such as rationing, access to care. and the role of the federal government in regulating health care. There was a high level of agreement between the three groups that society should provide health care to all citizens, and that individuals should have appropriate access. There was also a general preference for being treated in a fee-for-service setting. Some differences were that medical students held more negative views about managed care than some of the others. The students tended to disagree on cost controls, particularly on issues that might impact on their own professions. Medical students were more restrictive than others on concepts of rationing health care and with regard to high tech procedures. Thus the results reflect areas of extensive agreement, but also the fact that even at entry students may differ on issues that are likely to have an economic impact on their careers. The relationship of these attitudes to the changing health care system and to theories about professionalism and the state is discussed.
先前关于对医疗保健系统态度的研究中一个未解决的问题是,医学生所持有的价值观是他们所独有的,还是仅仅是一种群体现象。本研究通过测量医学院入学时的价值观和态度,并将其与另外两组在入学时的学术地位和社会地位可能相当的人群(商科和法律专业学生)进行比较,来解决这个问题。本文涉及四个实质性领域:管理式医疗、诸如配给等成本控制、医疗服务的可及性,以及联邦政府在监管医疗保健方面的作用。三组人群高度一致地认为,社会应该为所有公民提供医疗保健,并且个人应该能够获得适当的医疗服务。他们也普遍倾向于在按服务收费的环境中接受治疗。存在一些差异,比如医学生对管理式医疗的看法比其他一些人更为负面。学生们在成本控制方面往往存在分歧,特别是在可能影响他们自身职业的问题上。医学生在医疗保健配给概念以及高科技程序方面比其他人更为保守。因此,研究结果既反映了广泛的共识领域,也反映了这样一个事实,即即使在入学时,学生们在可能对其职业产生经济影响的问题上也可能存在分歧。本文还讨论了这些态度与不断变化的医疗保健系统以及关于专业精神和国家的理论之间的关系。