Causal Responsibility and Rationing in Medicine

The article addresses the issue of rationing health care services, a topic currently being hotly debated in many countries. The author argues that the aspect of causal responsibility ought to play a decisive role in the allocation of limited medical resources. Starting out from Ronald Dworkin's distinction between option luck and brute luck, the appropriate and meaningful uses of the term causal responsibility are clarified first. A discussion of the conditions which might justify giving lower priority to patients whose illnesses are the result of unhealthy behavior, like e.g. alcohol abuse, follows. Causal responsibility is then viewed in the context of private health insurance and the club model of organ donation. It is argued that individuals themselves are basically responsible for their decisions regarding insurance coverage and membership in organ donors' clubs. Causal responsibility is shown to be a more suitable criterion for rationing scarce medical resources than other criteria which might alternatively be considered, such as patients' age.     

The use of genetic test information in insurance: The argument from indistinguishability reconsidered

In the bioethical literature, discrimination in insurance on the basis of genetic risk factors detected by genetic testing has been defended and opposed on various ethical grounds. One important argument in favour of the practice is offered by those who believe that it is not possible to distinguish between genetic and non-genetic information, at least not for practical policy purposes such as insurance decision-making. According to the argument from indistinguishability, the use of genetic test information for insurance purposes should be permitted, because genetic test information is no different from non-genetic medical information in any relevant respect, therefore it would be inconsistent to prohibit the former whilst permitting the latter. This paper discusses and defends this argument and suggests a new, more tenable foundation.     

眼睛注视线索对经济领域风险决策的影响：基于框架效应范式

采用基金投资框架任务,结合眼动技术考察眼睛注视线索与框架类型对风险决策的影响。结果发现：（1）消极眼睛注视线索促进了被试在损失框架下的风险寻求行为,控制组与积极、中性、消极眼睛组的行为结果无显著差异;（2）以均字注视次数为指标的眼动结果表明,积极眼睛组和中性眼睛组对确定损益的关注差异大于对风险损益的关注差异;消极眼睛组和控制组被试对损失的关注大于对收益的关注,对确定项的关注大于对风险项的关注,但两者不存在交互作用。消极眼睛注视线索可能改变了个体对风险性和确定性的感知,并因此影响了人们的风险决策行为,规避消极情绪线索可能有助于减少经济决策中的风险寻求行为。     

终末期肾病单病种付费方式患者满意度调查分析

本研究通过调查分析终末期肾病患者对当前单病种付费方式的满意度及影响因素,为医疗保险支付方式改革提供政策依据.研究采用典型抽样方法,对某市四家三级甲等医院257名透析治疗参保患者进行现场自填式问卷调查,调查结果显示,调查人员对终末期肾病单病种付费方式总体满意度为97.3％,对特约医疗机构的满意度高于对医疗保险政策的满意度.患者满意度的主要影响因素有治疗方式、文化程度和家庭收入.医疗保险部门应关注单病种付费政策的结算范围,增加医疗困难救助,加强对医护人员医疗保险政策的宣传,提高患者满意度.     

医疗风险防范与化解新趋向

新的《医疗事故处理条例》实施以后,患者的自我保护意识不断增强、高精尖医疗器械的应用、新技术的不断开展等均增加了医疗行为的风险,医疗风险管理显示出日益重要的作用。新形势下医疗风险管理的新趋向是建立自愿的医疗责任保险、组织患者参加医疗风险保险、建立强制性医疗责任保险制度、卫生行政部门代理保险业务、建立医疗援助基金等方式,提出了在风险控制的基础上,加强风险融资的措施。     

医院和医疗保险的经济学分析

随着医疗卫生体制改革的深入,应对老龄化危机,降低不断提高的医疗服务费用,提高医疗服务质量,提高医疗服务可及性和公平性,是我们面对的切实问题.医院是提供医疗卫生服务的场所,也是提供医疗卫生服务的主体单位,了解医院的经济学特性和组织特点,有利于我们对市场经济环境下的医院行为有所了解,为卫生体制改革和医疗保险改革提供理论依据.     

建立风险管理机制防范医疗纠纷的探讨

"医疗风险无处不在".针对医疗纠纷的起因及医疗风险管理的办法阐述了国内外医疗风险管理的现状,提出医疗风险管理的建议,使医疗风险管理规范化、制度化、社会化.     

医疗保险支付方式的研究进展

医疗保险支付方式是医疗保险体制改革的重点与难点,直接关系着医疗保险各方的经济利益,影响医疗保险制度的平稳运行,也是医疗保险费用控制的关键。就国内外医疗保险支付方式的研究现状及进展进行综述,并进一步提出医疗保险支付方式的发展趋势。     

社会医疗保险道德风险博弈与防控措施研究

通过对社会医疗保险道德风险产生原因与特征的探讨,根据不完全信息重复博弈模型对社会医疗保险道德风险进行了系统分析,据此提出了社会医疗保险道德风险的防控措施,以期实现对道德风险的有效防控,提高社会医疗保险基金的安全。     

新加坡医疗保障体系的特点及对我国的启示

新加坡的卫生状况在国际上处于较高水平,得到了世界卫生组织的较好评价,本文主要介绍了新加坡医疗保障体系在医疗费用的分担、体系的完善、资金的筹集方式和报销制度等方面的特点,并结合我国的具体国情和医疗保障体系的现状,总结了其对我国医疗保障体系建立和完善的几点启示。