医療における公正 : 医療サービスの特性を手がかりとして
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概要
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rights: 本文データは社会・経済システム学会の許諾に基づきCiNiiから複製したものであるFive distributive problems are discussed.These are (1)traits of medical services and distributive justice.(2)Innovation and its diffusion in medical technology and distributive justice.(3)Conflicts of distributive rules in hospital resources and among constituents.(4)Distributive justice and restriction of patients'life chance.(5)Unintended consequences of priority in distribution and provision of buffer stock in medical resources.Firstly, medical services have some traits that inherently cause distributive problems.These traits are professional discretion, information gaps between doctor and patients, technical difficulty and form of private supply in medicine.Because of them distributive injustice cases could be cut into patient's private unlucky cases or attributed to individual dissatisfaction.So, we must be careful not to be caught into this trap.Secondly, innovation and its diffusion in medical technology can make some medical treatments free from distributive problems.But at the same time, it can produce another distributive problems in more crucial diseases.Innovation continuously changes basic condition of distribution, so distributive justice in medicine will change accordingly.We find that sever distributive problems occur not in the part of top innovation, but in moderate innovation.Thirdly, hospitals are constituted of many professinal or non-professinal staffs and variety of patients.Each members has own resources to be offered and distributive rules to follow.But, he sometimes uses the rules outside his control area so conflicts occour between rules.These conflicts partly account for distributive problems in hospitals.Typical example of this is a conflict between achievement principle in staffs and need principle in patients.Fourthly, patients not only consume medical resources, but also undergo restrictions of their life chances in hospital.These restrictions are legitimated by the necessity for recovery.But are there any unnecessary restrictions in them?Doesn't it tend to be a hidden punishment for patients?These are still the questions to be answered.Lastly, there are unintended consequences of priority in distribution and provision of buffer stock in medicine.Medical system partly falls into a vicious circle, produces huge cost and sluppies unnecessary service on the basis of buffer provision and a back up system.
- 社会・経済システム学会の論文
- 1989-10-25