London School of Hygiene and Tropical Medicine, London, UK.
Value Health. 2013 Jan-Feb;16(1 Suppl):S39-45. doi: 10.1016/j.jval.2012.10.001. Epub 2012 Nov 15.
Over the past 50 years, health care has been making a growing contribution to population health in many countries. Yet its benefits are still denied to many people worldwide. This article describes how many countries, both developed and developing, have pursued the quest to achieve universal health care. This has been an explicitly political process. In Europe, it emerged from a belief in solidarity, a fear of revolution, and a changing view of the role of the state. In developing countries, progress was more erratic, characterized by debates about the affordability of universal health care, until it was realized that functioning health systems were essential to deliver development goals. Throughout, the United States has been an exception. An analysis of progress toward universal health care, combining a review of existing theories and new empirical analysis, identifies five factors as important: the strength of organized labor and left-wing parties, adequate economic resources, absence of societal divisions, weakness of institutions that might oppose it (such as organized medicine), and windows of opportunity. Having noted the substantial benefits accruing from universal health care, the article concludes with an analysis of how universal health care is under threat in some European countries and a warning about the risks posed by current radical austerity policies.
在过去的 50 年里，医疗保健在许多国家对人口健康做出了越来越大的贡献。然而，其益处仍然被世界上许多人所否认。本文描述了许多发达国家和发展中国家是如何追求实现全民健康覆盖的目标的。这是一个明确的政治过程。在欧洲，它源于对团结的信念、对革命的恐惧，以及对国家角色的看法的改变。在发展中国家，进展更为曲折，其特点是关于全民健康覆盖的可负担性的争论，直到人们意识到有效的卫生系统对于实现发展目标至关重要。自始至终，美国都是一个例外。对实现全民健康覆盖的进展进行了分析，结合了对现有理论和新的实证分析的回顾，确定了五个重要因素：有组织的劳工和左翼政党的实力、充足的经济资源、不存在社会分裂、可能反对全民健康覆盖的机构薄弱（如有组织的医学）以及机会之窗。本文在指出全民健康覆盖带来的巨大好处之后，分析了一些欧洲国家的全民健康覆盖面临的威胁，并对当前激进的紧缩政策带来的风险提出了警告。
