医疗保健保险改革的伦理视角..doc

507 of 829 DOCUMENTS Copyright (c) 1993 Boston University School of Law. American Journal of Law Medicine 1993 19 Am. J. L. and Med. 37 LENGTH: 19479 words An Ethical Perspective on Health Care Insurance Reform NAME: Troyen A. Brennan * BIO: * Professor of Law and Public Health, Harvard School of Public Health. Katherine Swartz, Rashi Fein, Marcia Angell, Linda and Zeke Emanuel, and Fran Miller all provided helpful comments on an earlier draft, as did participants at a seminar of the Division of Medical Ethics of Harvard Medical School. SUMMARY: ... Much recent analysis of health care insurance reform emphasizes economic and policy issues. ... It sketches an ethical framework for evaluating health policy and presents seven specific propositions that an ethical analysis of health care reform proposals raises. ... This approach leads to an ethics of health policy that would resonate with medical ethics, but not necessarily retain the current institutional structure of medical care. ... The three principles that guide an ethics of health policy (patient commitment, institutional commitment, and provider community orientation) represent an alternative to the top-down pathway to health care reform that moves from a theory of justice, to calculated just amounts of the primary good (medical care), and then to clinical ethics. ... As compared to an economic or political analysis, an ethical analysis that incorporates altruistic concern for the class of all patients, insists that institutions of medical care reflect the same kind of caring that individual providers do for their patients, and recognizes that providers must work concertedly for ethical goals provides a different perspective on health care cost and financing reform. ... An ethics of health policy, however, must also have an institutional perspective and must address the costs associated with medical care. ... TEXT: [*37] Much recent analysis of health care insurance reform emphas