The role and education of doctors in the delivery of health care
The role and education of doctors in the delivery of health care
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DOI：
10.1016/s0140-6736(99)01075-2
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发表时间：
1999-04-03
期刊：
影响因子：
168.9
通讯作者：
Chantler, C
中科院分区：
文献类型：
--
作者：
Chantler, C
优先事项和选择关于如何最好地为卫生保健服务提供资金的争论不应让我们逃避这样一个简单的事实，即卫生保健是由提供服务的公民提供资金的。除了少数人直接支付医疗费用外，大多数公民通过某种形式的保险支付医疗费用，无论是私人组织的还是通过国家组织的。鉴于所有社会现在都必须就提供何种保健、向谁提供保健以及在何种情况下提供保健作出选择，在支付保健费用的社会利益与患病个人的需求之间出现了紧张关系，他们相当合理地认为，他们所需要的一切形式的治疗和护理，应该在他们需要的时候提供。最近成立的英国国家临床卓越研究所（见柳叶刀3月27日，第xxx页）将就新的和当前的技术提供适当的医疗保健建议。虽然可以制定国家优先事项框架，但地方灵活性很重要，地区卫生当局和今后的初级保健团体将在委托提供服务方面发挥重要作用。如果保险公司（在我们的情况下，NHS）代表社会行事，决定优先事项和选择，有需要的个人也应该能够在这个框架内做出选择。医生在管理方面的角色面对医疗服务的成本不断上升，以及有需要决定医疗服务的优先次序和选择，负责资助医疗服务的人士设法规管医生的活动，并限制他们的自主权，这是不足为奇的。临床医生有一个选择，要么成为管理的一部分，要么被管理。我认为，他们分担管理制度的责任，并能更好地维护其专业操守，对病人最有利。在资金有限的情况下浪费资源不可避免地意味着拒绝对其他人进行适当的治疗;因此，临床医生有参与的道德责任。此外，临床自由需要资源;如果我们最大限度地利用现有资源，我们将能够更好地造福患者。因此，医生需要考虑五个E。●有效性-治疗有效吗？●灵活性--它在实践中的效果如何？●效率-是否以最小的投入获得最大的产出？
Priorities and choices Arguments about how best to fund health-care services should not allow us to escape the simple truth that health care is funded by the citizens for whom the service is provided. Except for the few people who pay directly for their health care, most citizens pay for health care through some form of insurance, whether organised privately or through the state. Given that all societies now have to make choices about what health care is to be delivered, to whom, and under what circumstances, there develops a tension between the interests of society that pays for the delivery of health care and the needs of individuals who are ill, who quite reasonably believe that everything they need in the form of treatment and care ought to be available when they need it. It is intended that the recently formed National Institute for Clinical Excellence in the UK (see Lancet March 27,, p xxx) will advise on appropriate health-care provision with regard to new and current technology. Although a national framework for priorities can be set, local flexibility is important, and district health authorities and, in future, primary-care groups will have important roles in commissioning services. If the insurer (in our case the NHS), acting on behalf of society, is to determine priorities and choices, individuals who are in need should also be able to make choices within this framework. The question that arises is what role, if any, doctors should have in this process.The role of doctors in management Faced by the rising cost of the delivery of health care, and the need to determine priorities and choices, not surprisingly those responsible for funding health care have sought to regulate the activities of doctors and to restrict their autonomy. Clinicians have a choice, either to be part of the management, or to be managed. I contend that they will benefit their patients most by taking their share of the responsibility for managing the system and be better able to maintain their professional integrity. Profligacy in the use of resources where funding is limited inevitably means the denial of appropriate treatment to someone else; thus, clinicians have an ethical responsibility to be involved. Also, clinical freedom requires resources; if we maximise the resources that are available, we will be better able to benefit patients. Doctors therefore need to have regard for the five ‘E’s.● Efficacy—Does the treatment work?● Effectiveness—How well does it work in practice?● Efficiency—Is the maximum output obtained for the minimum input?