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首页> 外文期刊>Journal of Health Services Research & Policy >Explicit and implicit rationing: taking responsibility and avoiding blame for health care choices
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Explicit and implicit rationing: taking responsibility and avoiding blame for health care choices

机译：显式和隐式配给：承担责任并避免为医疗保健选择承担责任

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Rationing health care in publicly funded health care systems is becoming more challenging because of the growingngap between the possibility of effective medical intervention and limited resources. This poses both an economicnchallenge and a political puzzle. On the basis of experience in those systems that have adopted a systematicnapproach to rationing, it can be suggested that the dilemmas involved should be addressed by strengthening bothnthe information base to support decisions and the institutional framework in which decisions are taken. Thencontribution both of experts and of lay people is needed to inform decision-making, and the processes adoptednneed to allow for this as well as being transparent and accountable. In practice, rationing is likely to combine explicitnand implicit decision-making and to result in the exclusion of services at the margins and the development ofnguidelines in the mainstream. The politics of rationing may favour muddling through and the evasion ofnresponsibility but this will be dif. cult to sustain in an environment in which public awareness of decision-making innhealth care is growing.
机译：由于有效医疗干预的可能性与有限资源之间的差距越来越大，在公共资助的卫生保健系统中分配卫生保健正变得越来越具有挑战性。这既构成经济挑战，也构成政治难题。根据那些采用系统化定量配给方法的系统的经验，可以建议应通过加强支持决策的信息基础和进行决策的体制框架来解决所涉及的难题。然后，需要专家和非专业人士的共同参与来为决策提供依据，并采用必要的流程来做到这一点，并使之透明且负责。在实践中，定量配给可能将显性决策和隐性决策结合起来，导致边缘地区的服务被排斥在外，主流准则的发展。配给的政治可能会助长混乱和逃避责任，但这将是困难的。邪教组织要在公众对医疗保健决策意识日益增强的环境中维持。

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