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新医改伦理价值的实践困境与政策应对——以按病种付费政策为例
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| 投稿时间： 2014-10-27 最后修改时间： 2014-12-25 摘要点击次数: 2339 全文下载次数: 5 |
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| 引用本文：叶子辉, 王兆良.新医改伦理价值的实践困境与政策应对——以按病种付费政策为例[J].中国卫生政策研究,2015,8(2):46-53 |
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| 叶子辉1,2, 王兆良1,2 |
1. 安徽医科大学人文社会科学学院 安徽合肥 230032;
2. 安徽医科大学医学人文研究中心 安徽合肥 230032 |
| 基金项目:安徽省高校人文社科重大项目(SK2014ZD0036);南京医科大学人文医学协同创新中心资助课题;安徽省"研究生千人计划"项目;安徽医科大学重点学科(201003-09)阶段性研究成果 |
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| | 摘要:新医改的政策应当遵循总效原则、不伤害原则、公平正义原则等公共政策的伦理价值标准。按病种付费制度作为新医改中的重要政策在全国范围内的试点与推广,在抑制医疗费用增长过快和过度医疗方面发挥了重要作用。在伦理价值向度上,按病种付费制度规避了不道德的个体、遵循了新医改的总效原则、实现了社会保障的公正思想,但也产生了抑制个体健康需求、增加医疗机构的伦理风险以及对医学科研发展产生消极影响等方面的问题。要实现按病种付费制度的合理发展,需要完善按病种付费自身的制度建设,保障政策的合理可行;建立有序的配套措施,保障制度的推广与实施;增加政府的财政投入,保障公立医院的公益性;建立良好的沟通机制,加强医疗机构与保险机构的互动等。 | |
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关键词:新医改 伦理问题 价值标准 按病种付费
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| Dilemma and policy proposal for the ethical value of new health care reform: From the perspective of Diagnosis Related Groups |
| YE Zi-hui1,2, WANG Zhao-liang1,2 |
1. School of Humanities & Social Science, Anhui Medical University, Hefei Anhui 230032, China;
2. Medical Humanities Research Center, Anhui Medical University, Hefei Anhui 230032, China |
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| | Abstract:Health care policy should follow principles of total efficiency, no-harm, fairness and justice as ethical standards for public policy. Diagnosis Related Groups(DRGs) as a sign of new health care reform (NHCR) is implemented as a pilot program across the country, with the obvious function of suppressing excessive growth in medical costs and over-treatment. From the dimension of ethical values, the DRGs has avoided unethical individuals, followed the principle of total efficiency and achieved the equalization of social security. However it has also increased ethical risks and been adverse to the development of medical research. To realize the reasonable development of DRGS, the construction of DRGs must be improved, and security policies must be reasonable and feasible; orderly measures must be established to ensure promotion and implementation; the government's financial investment must be increased to protect the social welfare of public hospitals; a sound communication mechanism must be implemented, and interaction between medical institutions and insurance institutions must be strengthened. | |
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