The health professions and the performance of future health systems in low-income countries: Support or obstacle?
The health professions and the performance of future health systems in low-income countries: Support or obstacle?
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DOI：
10.1016/j.socscimed.2008.01.035
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发表时间：
2008-05-01
影响因子：
5.4
通讯作者：
Dussault, Gilles
中科院分区：
文献类型：
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作者：
Dussault, Gilles
本文讨论了低收入国家卫生服务提供系统中卫生专业人员目前和未来的作用。与较富裕国家不同，大多数低收入国家没有劳动力市场监管的传统，专业人员本身监管其成员提供保健服务的能力往往较弱。该文件研究了专业垄断对卫生服务提供系统绩效的影响，例如获取的公平性、服务的有效性、稀缺资源的使用效率、对用户需求的响应，包括防止利用卫生服务带来的财务影响。它确定了决策者在开放卫生劳动力市场同时保证专业人员提供服务的安全方面面临的问题。有人建议，一项“社会契约”可能是一个可行的行动方针，即给予执业特权，以换取积极维持和提高其服务质量的承诺。这将要求政策进程中的行动者合作加强管理机构履行其作用的能力。(C) 2008 Elsevier Ltd版权所有。
This paper discusses the present and future role of the health professions in health services delivery systems in low-income countries. Unlike richer countries, most low-income countries do not have a tradition of labour market regulation and the capacity of the professions themselves to regulate the provision of health services by their members tends to be weak. The paper looks at the impact of professional monopolies on the performance of health services delivery systems, e.g. equity of access, effectiveness of services, efficiency in the use of scarce resources, responsiveness to users' needs, including protection against the financial impact of utilising health services. It identifies issues which policy-makers face in relation to opening the health labour market while guaranteeing the safety and security of services provided by professionals. The suggestion is made that a "social contract", granting privileges of practice in exchange of a commitment to actively maintain and enhance the quality of their services, may be a viable course of action. This would require that the actors in the policy process collaborate in strengthening the capacity of regulatory agencies to perform their role. (C) 2008 Elsevier Ltd. All rights reserved.