Frenk J, González-Block M A
National Institute of Public Health, Cuemavaca, Morelos, Mexico.
Health Policy. 1992;21(2):167-80. doi: 10.1016/0168-8510(92)90016-5.
Up to now, the Swedish health care system has been used as a model for comparisons with other developed nations, chiefly in Northern Europe and the United States. This article departs from the mainstream and poses that similarities along the political factor of corporatism warrant a comparative analysis between the Swedish and Mexican cases. The most widely accepted definitions and typologies of corporatism are reviewed. The arena of manpower policy is used to illustrate the effects of alternative modes of interest representation on health care organization. The final aim of this comparative exercise is to enrich the empirical basis required to build a theory about the complex determinants of health care systems. State corporatism has acted in Mexico largely unchecked by geographical interest representation, in contrast with Sweden where centralist and decentralist forces are more balanced. This finding helps to understand why Sweden and Mexico mark extreme points along the health equity continuum. The comparison underscores the need for Sweden to avoid the risk of weakening the equity basis of its health care system as it moves along its current reform. The importance of these transformations go beyond Sweden, since they will undoubtedly offer new models of thinking and acting for the rest of the world.
到目前为止，瑞典医疗保健系统一直被用作与其他发达国家（主要是北欧国家和美国）进行比较的典范。本文另辟蹊径，提出社团主义这一政治因素方面的相似性使得瑞典和墨西哥的案例值得进行比较分析。文中回顾了社团主义最广泛接受的定义和类型。人力政策领域被用来阐释利益代表的不同模式对医疗保健组织的影响。此次比较研究的最终目的是丰富构建关于医疗保健系统复杂决定因素理论所需的实证基础。与瑞典相比，瑞典中央集权和地方分权力量更为平衡，而墨西哥的国家社团主义在很大程度上未受到地域利益代表的制约。这一发现有助于理解为何瑞典和墨西哥在卫生公平连续体上处于极端位置。该比较强调瑞典在推进当前改革过程中需要避免削弱其医疗保健系统公平基础的风险。这些变革的重要性不仅限于瑞典，因为它们无疑将为世界其他地区提供新的思维和行动模式。
