In general, responsiveness contribu

In general, responsiveness contributes to health by promoting utilization, but that is not
always the case. Greater autonomy can mean that people do not take up an intervention
because they perceive the individual benefit to be small or the risk to be substantial, and do
not value the collective or population benefit. This is particularly likely for immunization,
especially if there is fear of adverse reactions. Individual freedom to choose whether or not
to be immunized is in conflict with the public health objective of high coverage to prevent
epidemics. Such conflict has occurred, for example, in the United Kingdom for pertussis
and in Greece for rubella vaccine (10). The overall performance of a health system may
therefore involve trade-offs among objectives.
Opinions on how well a health system performs on such subjective dimensions as responsiveness
might be influenced by any of a number of features of the systems themselves,
or of the respondents. Since poor people may expect less than rich people, and be
more satisfied with unresponsive services, measures of responsiveness should correct for these differences, as well as for cultural differences among countries (11). Even without
such adjustment, comparisons of how knowledgeable observers rate health system achievements
can reveal on which aspects of responsiveness a system seems to satisfy its users
best. Judgements about average level and inequality of the components of responsiveness
were developed in each of 35 countries by a network of 50 or more key informants. A
separate survey of over a thousand respondents was used to develop weights for combining
these scores into an overall rating. Box 2.2 describes the results of this exercise. Estimates
for other Member States were derived from the 35 observations, adjusted for
differences among countries and informant groups. Surveys of population opinion and
direct observation of health provision can both be used to complement these judgements.
Figure 2.4 illustrates in detail the scores of the seven individual elements, relative to the
overall score, within each of 13 countries chosen to reflect all WHO Regions and typical of
the entire set of countries studied. The health systems examined always appear to perform
relatively well on the two dimensions of access to social support networks and confidentiality,
sometimes very much better than on other aspects. The systematically high rating for
social support may reflect a trade-off against the quality of amenities, because a health care
facility that cannot, for lack of resources, offer good quality food or non-medical attention
can compensate for that by allowing relatives and friends to attend to patients’ needs. One
reason why confidentiality seems not to be a problem in these countries may be that there
is little private insurance and therefore little risk of coverage being denied because a provider
reveals some information about a patient. There is somewhat less consistency at the
other end of the scale, but autonomy is among the three lowest-rated elements of responsiveness
34 times out of 35 – and the lowest ranked element almost half the time – and
performance is also often poor with respect to choice of provider and promptness of care.
As with health status, it is not only overall responsiveness that matters, if some people
are treated with courtesy while others are humiliated or disdained. A perfectly fair health
system would make no such distinctions, and would receive the same rating of responsiveness on
every element, for every group in the population. In almost every country where key informants
were surveyed, the poor were identified as the main disadvantaged group. In particular,
they were considered to be treated with less respect for their dignity, to have less choice of
providers and to be offered poorer quality amenities than the non-poor. In nearly as many
cases, rural populations – among whom the poor are concentrated – were regarded as
being treated worse than urban dwellers, suffering especially from less prompt attention,
less choice of providers and lower quality of amenities. Some respondents in one or several
countries also identified women, children or adolescents, indigenous or tribal groups or
others as receiving worse treatment than the rest of the population.
The elements of client orientation, where the poor and the rural population are less well
treated, all have economic implications: it generally costs more to assure quick attention
and to offer high quality food, more space and well-kept facilities. It also makes cost control
harder if people are allowed to choose their providers, and costs differ among them. The
strongest associations occur for quality of basic amenities and promptness of attention. The
former is closely related to income per head and to the share of private expenditure in total
health spending; the latter is closely related to average years of schooling of the population,
which is also associated with income. In contrast, the elements of respect for persons can
be costless, apart perhaps from some training of providers and administrators. These elements
– respect for dignity, autonomy, and confidentiality – show no relation to health
system spending. There is scope for improving health system performance in these respects
without taking any resources away from the primary objective of better health. This

結果 (繁體中文) 1:

一般情況下，回應能力有助於健康促進利用，但這並不是總是這樣。更大的自主權可能意味著人們不佔用干預因為他們察覺到個人利益被小或風險很大，和做不是值的集體或人口的利益。這是免疫接種，特別是可能尤其是如果有恐懼的不良反應。個人的自由選擇是否或不要進行免疫接種是與公共衛生目標的高覆蓋率，以預防衝突流行病。這種衝突發生，例如，在聯合王國為百日咳在和希臘的風疹疫苗 (10)。衛生系統的整體性能可以因此，涉及目標之間的權衡取捨。衛生系統如何進行回應能力等主觀方面的意見可能受到任何數目的系統本身的功能或被訪者。因為窮人可能期望減少比有錢的人，並將更多服務感到滿意，反應遲鈍，回應措施應糾正這些差異，感謝國家 (11) 之間的文化差異。即使沒有這樣的調整，如何知情的觀察家比較率衛生系統成就可以顯示在哪些方面回應系統似乎滿足其使用者的需求最好。平均水準和不平等的元件的回應能力的判斷35 個國家，每年制定了網路 50 或更關鍵的告密者。A另一項調查的受訪者超過一千被用來開發相結合的權重這些分數換成整體的評級。方框 2.2 描述該練習的結果。估計數對於其他的會員國來自 35 的意見，調整為國家和告密者群體之間的差異。人口意見調查和直接觀察的健康提供可以兩者都用於補充這些判斷。圖 2.4 詳細說明了幾十個人的七個要點，相對於整體評分，每個 13 國家選擇以反映所有世衛組織區域和典型的內研究國家整個集。總是檢查衛生系統似乎執行在獲得社會支援網路和機密性的兩個維度上相對較好有時比好其他的方面。有系統地高評級社會支援可能反映品質的設施和服務，做出取捨，因為衛生保健不能因為缺乏資源，提供優質食物或非醫療關注的設施可以彌補，通過允許親戚和朋友照顧病人的需要。一個保密不似乎是在這些國家的問題的原因可能是有是小的私人保險和因此小風險的覆蓋面被拒絕，因為提供程式揭示了一些關於病人的資訊。還有在一致性稍差另一端的規模，但自治是回應三個最低額定要素之間34 倍出 35 — — 和最低排名的元素幾乎一半的時間和性能往往也是差的供應商的選擇和護理的及時性。與健康情況，它不是只有總體回應能力的事情，如果有些人有禮貌的對待而別人是侮辱或不屑。一個完全公平的健康系統將使沒有這樣的區別，並會收到回應相同評級為每個組在人口中的每個元素。幾乎每個國家在那裡主要資訊提供者被調查，窮人被確定為主要的弱勢群體。尤其是，他們被認為對待不太尊重他們的尊嚴，沒有選擇的餘地供應商，可以提供比非窮人的貧窮品質一切設施。在幾乎一樣多情況下，農村人口 — — 其中就窮人有集中 — — 被視為更糟糕的是比城市居民，尤其患有不及時關注、 正在接受治療更少的選擇供應商和低品質的設施和服務。一些受訪者中的一個或幾個國家還確定了婦女、 兒童或青少年，土著或部落群體或其他人作為接收比其餘人口較差的待遇。用戶端定位，窮人和農村人口是不好的元素治療，所有產生的經濟影響: 它通常要花費更多保證快速注意並提供高品質的食物、 更多空間和設施完好。這也使得成本控制更難的如果人們允許選擇它們的供應商和成本不同在他們之中。的最強的協會發生的基本設施和服務的品質和及時性的注意。的前者是密切相關，人均收入和私人開支總數中所占份額衛生支出;後者是密切相關的人口，平均年限這也是與收入相關聯。相比之下，尊重人的元素可以是代價，也許除了一些培訓的提供者和管理員。這些元素— — 尊重尊嚴、 自主權和保密性 – 顯示沒有與健康的關係系統的開銷。為改善在這些方面的衛生系統績效的餘地沒有考慮任何資源更好的健康的首要目標。這

結果 (繁體中文) 3:

在一般情况下，響應能力有助於促進健康的利用，但這並不總是這樣的情况下。更大的自主性可能意味著人們不採取干預措施，因為他們認為個人利益是小的，或風險是實質性的，並且不重視集體或群體的利益。這是特別有可能免疫，特別是如果有不良反應的恐懼。個人自由選擇是否為免疫與高覆蓋率的公共衛生目標相衝突，以防止傳染病。例如，這種衝突已經發生，例如，在英國，百日咳，和希臘的風疹疫苗（10）。一個健康系統的整體效能，可以囙此，涉及的目標之間的權衡，以及健康系統如何執行這樣的主觀方面的響應能力，可能會受到影響的任何系統本身的一些功能，或受訪者。由於窮人可以預期不到富裕的人，和更滿意的反應遲鈍的服務，措施的響應性應糾正這些差异，以及文化差异的國家（11）。即使沒有這樣的調整，比較知識的觀察員率健康系統的成就，可以揭示的響應一個系統的方面，似乎滿足其用戶的最佳。反應性成分的平均水準和不平等性的判定