مسئولیت فردی در قبال سلامت در اولویت‌گذاری ارائه خدمات سلامت توسط سیاست‌گذاران عرصه بهداشت و درمان در ایران
محورهای موضوعی : -مدیریت خدمات بهداشتی و درمانی
نادر شیخ الاسام کندلوسی
1
,
ندا نفری
2
,
سحر کوهستانی
3
1 - استادیار، گروه مدیریت دولتی، واحد تهران شمال، دانشگاه آزاد اسلامی، تهران، ایران
2 - استادیار، گروه مدیریت دولتی، واحد تهران شمال، دانشگاه آزاد اسلامی، تهران، ایران
3 - دانشجوی دکتری گروه مدیریت دولتی گرایش خط‌مشی‌گذاری، واحد تهران شمال، دانشگاه آزاد اسلامی، تهران، ایران
کلید واژه: سیاست‌گذاری سلامت, اولویت‌گذاری, مسئولیت سلامت, اهداء عضو,
چکیده مقاله :
مقدمه: مسئولیت فردی در قبال سلامت و استفاده از آن به عنوان معیاری جهت تخصیص منابع کمیاب این بخش موضوعی است که امروز مورد توجه سیاست‌گذاران این حوزه قرار گرفته است لذا این مقاله با هدف بررسی نقش مسئولیت فردی سلامت در اولویت‌گذاری ارائه خدمات سلامت از دیدگاه متقاضیان اهدای عضو مراجعه‌کننده به مرکز اهدای عضو شهرستان مشهد در بهار 1400 انجام شده است.روش پژوهش: این مطالعه توصیفی - تحلیلی در بین متقاضیان اهدای عضو انجام شده است. جمع‌آوری داده‌ها با استفاده از پرسشنامه استانداردی در رابطه با سنجش میزان نمایل اهدای عضو به دو بیمار متقاضی دریافت کبد صورت گرفته است. داده‌های پرسشنامه در نرم‌افزار جمع‌آوری و با استفاده از آمار توصیفی و آمار تحلیلی و در قسمت سوالات باز با استفاده از تحلیل محتوا آنالیزگردید.یافته‌ها: در نهایت از بین 214 پرسشنامه جمع‌آوری شده تحلیل‌ها بیانگر این بود که در بین پاسخ دهندگان تمایل به تخصیص کبد به متقاضیان دریافت عضوی که علت بوجود آمدن بیماریشان ارثی بوده 5 برابر بیشتر از تخصیص کبد به متقاضیانی که اعتیاد باعث بوجود آمدن بیماریشان بوده، می‌باشد. هم‌چنین 14 درصد شرکت‌کنندگان به این اصل که این که افراد تا حدودی در سلامتی و بوجود آمدن بیماریشان نقش دارند معتقد بودند.نتیجه‌گیری: مسئولیت‌پذیری می‌تواند معیار مهمی در تصمیم‌گیری برای اولویت‌گذاری در ارایه خدمات سلامت در بین سیاست‌گذاران باشد. با این وجود اجرایی شدن این اصل منوط به برنامه‌ریزی‌های بلندمدت و وجود زیرساخت‌ها و فرهنگ‌سازی‌های کلان و خرد در جامعه و محیط‌های بهداشتی درمانی و هم‌چنین افراد جامعه می‌باشد.
Introduction: Aimed at investigating role of personal responsibility for health in prioritization of providing health services from the viewpoint of organ donors referring to the Center for Organ Donation in Mashhad, Iran, the present research has been conducted in spring 2021.Methods: This is a descriptive – cross sectional study conducted among organ donors. Required data is collected via a standard questionnaire designed to measure tendency towards donating an organ to two patients seeking liver donation. Questionnaire data was fed into software where it was analyzed via descriptive and analytic statistics as wells as content analysis for open questions.Results: Finally, the analyses undertaken on 214 questionnaires collected indicated that, of total number of responders, the number of those who tended to donate their organs to patients with hereditary diseases was 4 – 5 times as large as the number of responders who tended to donate their organs to the drug addiction-resulted patients. Furthermore, 74% of the responders believed that, individuals actually take part in either their health or diseases.Conclusion: Responsibility for health represented an important factor in making decisions regarding the prioritization of providing health services among the responders. Presentation of comprehensive and neutral reasoning contributed to the elimination of misconceptions within the responders’ minds (if any), so that, with their minds opened, they can answer the questions in a non-biased manner. It is worth noting that, the responders had their opinions not significantly changed once they read the ideas raised in the questionnaire, and most of them still relied, in their choices, on the principle of responsibility for health.
1- Betancourt, R,Quinlan, J. Personal responsibility versus responsible options: health care, community health promotion, and the battle against chronic disease.Preventing Chronic Disease, 2017; 4(3): 1-3.
2- Wittenberg E, Goldie SJ, Fischoff B, et al. Rationing decisions and individual responsibility for health: are all lives equal? Med Decis Making, 2013; 23: 194.
3- Bringedal, B, Feiring,E. On the relevance of personal responsibility in priority setting: a cross-sectional survey among Norwegian medical doctors. J Med Ethics, 2019; 37: 357e361.
4- Horn, J. A rationale and test for the number of factors in factor analysis. Psychometrika, 2019; 30: 179–185. doi:10.1007/BF02289447 Cross RefPubMed.
5- Buyx, A.M. we should criterion: why we don't like it and why maybe Personal responsibility for health as a rationing. J Med Ethics, 2017; 34: 871-874.
6- Van der Star, s, van den Berg, B. Individual responsibility and health-risk behaviour: A contingent valuation study from the ex ante societal perspective. Health Policy, 2017; 101: 300– 311.
7- Wikler, D. Personal and Social Responsibility for Health. Ethics & International Affairs, 2012; 16(2) :47-55.
8- Brown, A. If We Value Individual Responsibility, Which Policies Should We Favour? Journal of Applied Philosophy, 2015; 22(1): 24-45.
9- Brudney D. Are alcoholics less deserving of liver transplants? Hastings Center Report; 2017.
10- Minkler M. Personal responsibility for health: contexts and controversies. In:Callahan D, ed. Promoting healthy behaviour. Washington: Georgetown University Press; 2020: 1–22.
11- Feiring E. Lifestyle, responsibility and justice. J Med Ethics, 2018; 6: 33-34.
12-Schmidt, H. Bonuses as Incentives and Rewards for Health Responsibility: A Good Thing? Journal of Medicine and Philosophy, 2017; 33: 198–220.
13- Sharkey K, Gillam L. Should patient with self-inflicted illness receive lower priority in access to healthcare resources? Mapping out the debate. J Med Ethics, 2010; 36: 661-5.
14- Cappelen AW, Norheim OF. Responsibility in health care: a liberal egalitarian approach. J Med Ethics, 2015; 31: 476e80.
15- Senjam S, Amarjeet S. Study of sense of coherence health promoting behavior in north Indian students. Indian J Med Res, 2011; 134(5): 645–652.
16- Walker S N, Hill. Polerecky D M. Psychometric evaluation of the Health-Promoting Lifestyle Profile II. Unpublished manuscript, University of Nebraska Medical Center; 2009
17- Glanz KA, Rimer B, Viswanath K. Health behavior and health education theory, Research and practice. 4th ed. San Farancisco: Josey- Bss publisher; 2018: 8-30.
18- Raieat A, Nourani Samiee Sibini F, Sadeghi T,Alimoradi Z, Study of health Promotion behavior in secondary school student in ghazvin, 2010. Journal of Hygiene and Health, 2018; 3(3): 46-53.
19- Yekaninejad MS, Akaberi A, Pakpour A. [Factors associsted with Physical Activity in adolescents in Qazvin: an application of the theory of planned behavior].Journal of North Khorasan University of Medical Sciences, 2017; 4(3): 449-456. (Persian)
20- Godin G, Kok G. The theory of planned behavior: A review of its applications to hearthrelated behaviors. American Journal of Health Promotion, 2019; 11(2): 87-98.
_||_1- Betancourt, R,Quinlan, J. Personal responsibility versus responsible options: health care, community health promotion, and the battle against chronic disease.Preventing Chronic Disease, 2017; 4(3): 1-3.
2- Wittenberg E, Goldie SJ, Fischoff B, et al. Rationing decisions and individual responsibility for health: are all lives equal? Med Decis Making, 2013; 23: 194.
3- Bringedal, B, Feiring,E. On the relevance of personal responsibility in priority setting: a cross-sectional survey among Norwegian medical doctors. J Med Ethics, 2019; 37: 357e361.
4- Horn, J. A rationale and test for the number of factors in factor analysis. Psychometrika, 2019; 30: 179–185. doi:10.1007/BF02289447 Cross RefPubMed.
5- Buyx, A.M. we should criterion: why we don't like it and why maybe Personal responsibility for health as a rationing. J Med Ethics, 2017; 34: 871-874.
6- Van der Star, s, van den Berg, B. Individual responsibility and health-risk behaviour: A contingent valuation study from the ex ante societal perspective. Health Policy, 2017; 101: 300– 311.
7- Wikler, D. Personal and Social Responsibility for Health. Ethics & International Affairs, 2012; 16(2) :47-55.
8- Brown, A. If We Value Individual Responsibility, Which Policies Should We Favour? Journal of Applied Philosophy, 2015; 22(1): 24-45.
9- Brudney D. Are alcoholics less deserving of liver transplants? Hastings Center Report; 2017.
10- Minkler M. Personal responsibility for health: contexts and controversies. In:Callahan D, ed. Promoting healthy behaviour. Washington: Georgetown University Press; 2020: 1–22.
11- Feiring E. Lifestyle, responsibility and justice. J Med Ethics, 2018; 6: 33-34.
12-Schmidt, H. Bonuses as Incentives and Rewards for Health Responsibility: A Good Thing? Journal of Medicine and Philosophy, 2017; 33: 198–220.
13- Sharkey K, Gillam L. Should patient with self-inflicted illness receive lower priority in access to healthcare resources? Mapping out the debate. J Med Ethics, 2010; 36: 661-5.
14- Cappelen AW, Norheim OF. Responsibility in health care: a liberal egalitarian approach. J Med Ethics, 2015; 31: 476e80.
15- Senjam S, Amarjeet S. Study of sense of coherence health promoting behavior in north Indian students. Indian J Med Res, 2011; 134(5): 645–652.
16- Walker S N, Hill. Polerecky D M. Psychometric evaluation of the Health-Promoting Lifestyle Profile II. Unpublished manuscript, University of Nebraska Medical Center; 2009
17- Glanz KA, Rimer B, Viswanath K. Health behavior and health education theory, Research and practice. 4th ed. San Farancisco: Josey- Bss publisher; 2018: 8-30.
18- Raieat A, Nourani Samiee Sibini F, Sadeghi T,Alimoradi Z, Study of health Promotion behavior in secondary school student in ghazvin, 2010. Journal of Hygiene and Health, 2018; 3(3): 46-53.
19- Yekaninejad MS, Akaberi A, Pakpour A. [Factors associsted with Physical Activity in adolescents in Qazvin: an application of the theory of planned behavior].Journal of North Khorasan University of Medical Sciences, 2017; 4(3): 449-456. (Persian)
20- Godin G, Kok G. The theory of planned behavior: A review of its applications to hearthrelated behaviors. American Journal of Health Promotion, 2019; 11(2): 87-98.