论英国国民健康服务体系中病人地位的改变

On the Change of Patients' Position in National Health Service

英国国民健康服务体系经历了半个多世纪的不断演变,病人地位的变化是这一演变过程的核心问题。国民健康服务体系的演变史,就是病人在医疗领域地位的发展史。该体系实施之初执行"以疾病为中心"的理念,它侧重疾病治疗的结果,强调病人就医机会的公平性。在这种医疗体系和文化中,医生具有绝对的主导性,病人是医疗服务的被动接受者,病患的权利及个性化与多样化的需求不被尊重、不被满足等现象非常普遍。从20世纪六七十年代开始,由于诸多因素的变化,特别是病患及其组织为维护自身权益的不懈努力,该体系的改革理念出现了由重治疗到预防的转变,传统的医患关系随之受到挑战,病人逐步成为医疗服务的主动选择者。"以病人为中心"的理念最终在英国得以确立,它强调病人就医的过程以及主动参与性,病人成为英国健康服务体系的中心。病人地位的发展过程亦是"以病人为中心"服务理念的确立与不断实现的过程,同时也是NHS体系内部结构不断完善、实现医疗资源最优化的过程。英国病人地位不断提高的事实亦折射出历届英国政府医改的基本经验:一是坚持了NHS"全民、全面和免费"的基本原则;二是尊重医学的科学性,提升医学的人文性;三是探求医疗资源的最优化。目前,英国国民健康服务体系是西方发达国家中以较少的支出实现普遍(基本)医疗较为成功的运作方式。然而在坚持NHS基本原则不变的前提下,实现医疗资源的最优化和病人的中心地位,依然是英国政府医改的一道难题。英国NHS中"以病人为中心"服务理念的未来发展依然值得期待。

In the continued evolution of National Health Service through more than 50 years,the change of patients' position is its core problem. The evolution of National Health Service is actually the history of patients' position in health service. The system emphasizes the results of disease treatments and the fairness in seeking health service. From the early 60 s and 70 s of the 20 th century,thanks to the patients' untiring endeavors and organizations to protect their rights,the reform idea has changed from treatment to precaution,and the patients gradually become the positive selector of health service. The patient-centered idea was finally established in Britain,and patients became the center of National Health Service( NHS). The change of patients' position shows the process of the confirmation and realization of patient-centered service idea and the perfection of internal structure of NHS. The fact reflected the medical reform is:firstly the insistence of NHS' ' all the people,all aspects and free of charge' principle; secondly the scientificity of medical science and raise humanity in medical science; thirdly the optimization of medical resources. However,the optimization of medical resources and patients' center position with unchanged principle of NHS is still a problem. The patient-centered service idea of NHS is still to be expected.