Berlinguer G
Int J Health Serv. 1992;22(1):45-51. doi: 10.2190/09TH-2Q3B-E38L-Q0X3.
If we compare the welfare state countries with others, from the point of view of both health and health services, the crisis concerns primarily the second group of countries. Nevertheless, difficulties arise also for welfare state policies. The problem is how to respond to neoconservative attacks on social and health rights, and how to change the bureaucratic and medicalized bias of the welfare state. The "golden era" of social insurance and health services, conceived as free access to funds to cope with all the growing needs of the population, is over. Limitations, controls, and priorities have to be established. In Italy and similar countries, the tendency is toward restricting health care for those who have greater needs, cutting funds for prevention, and creating greater inequalities. It is clear that the state must intervene to reduce social inequalities, but at the same time some existing differences (sexual, cultural, ethnic) have an intrinsic value that must be recognized. A policy of free-choice welfare is useful, and has nothing to do with the selective measures that are being introduced. Moreover, a key point has become the relationship between class and gender. The working class continues to be exploited, but new phenomena arise, connected with production and social reproduction and not limited to this sphere. It is true that gender includes social classes, but no social class may represent both sexes, or different ethnic groups, or gender itself.
如果从健康和卫生服务的角度将福利国家与其他国家进行比较，危机主要涉及第二类国家。然而，福利国家政策也面临困难。问题在于如何应对新保守主义对社会和健康权利的攻击，以及如何改变福利国家的官僚化和医学化倾向。被视为可免费获取资金以应对民众不断增长的所有需求的社会保险和卫生服务的“黄金时代”已经结束。必须确立限制、管控和优先事项。在意大利及类似国家，趋势是限制对有更大需求者的医疗保健，削减预防资金，并制造更大的不平等。显然，国家必须进行干预以减少社会不平等，但与此同时，一些现有的差异（性别、文化、种族）具有必须得到承认的内在价值。自由选择福利政策是有益的，且与正在推行的选择性措施毫无关系。此外，一个关键要点已成为阶级与性别的关系。工人阶级继续受到剥削，但出现了与生产和社会再生产相关且不限于该领域的新现象。诚然，性别包含社会阶层，但没有哪个社会阶层可以代表两性、不同种族群体或性别本身。
