Limits to health care: Fair procedures, democratic deliberation, and the legitimacy problem for insurers
Limits to health care: Fair procedures, democratic deliberation, and the legitimacy problem for insurers
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DOI：
10.1111/j.1088-4963.1997.tb00082.x
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发表时间：
1997-09-01
影响因子：
2.2
通讯作者：
Sabin, J
中科院分区：
文献类型：
--
作者：
Daniels, N;Sabin, J
当消费者“同意”以公平的市场价格购买涉及他们的产品时，限制是合法和公平的。解决限制决策的合法性和公平性问题只是使医疗保健系统成为整体的一部分。我们的医疗保健系统的设计特点也削弱了汽车购买的类比。卫生保健的目标是使人们的功能尽可能接近正常，从而为确保公平的机会均等作出了独特但有限的贡献。由于美国的医疗保健系统是公私混合的，关键的决定将由私人机构作出，这些机构为特定的患者群体报销和组织提供服务。具有讽刺意味的是，反对国家医疗保健改革的潜在障碍之一是，这将导致国家机构做出配给决定。因此，管理式护理组织或其他保险公司的承保决定实际上限制了许多患者获得治疗的机会。
Limits are legitimized and fair when consumers "consent" to purchase products involving them at fair market prices. Solving the legitimacy and fairness problems for limit-setting decisions is only part of what makes a health care system just overall. Features of the design of our health care system also undercut the car purchase analogy. Health care makes a distinctive but limited contribution to assuring fair equality of opportunity by aiming to keep people functioning as closely to normal as possible. Since the US health care system is a mixed public and private one, key decisions will be made by private institutions that reimburse and organize the delivery of services for specific groups of patients. Ironically, one of the bugaboos underlying opposition to national health care reform was that it would lead to national agencies making rationing decisions. The coverage decisions of managed care organizations or other insurers thus effectively restrict access to treatment for many patients.