Trappenburg M J
Department of Sociology and Anthropology, Amsterdam University/Aias, Plantage Muidergracht 12, 1018 TV, Amsterdam, The Netherlands,
Health Care Anal. 2015 Sep;23(3):207-20. doi: 10.1007/s10728-013-0260-5.
Traditional welfare states were based on passive solidarity. Able bodied, healthy minded citizens paid taxes and social premiums, usually according to a progressive taxation logic following the ability to pay principle. Elderly, fragile, weak, unhealthy and disabled citizens were taken care of in institutions, usually in quiet parts of the country (hills, woods, sea side). During the nineteen eighties and nineties of the twentieth century, ideas changed. Professionals, patients and policy makers felt that it would be better for the weak and fragile to live in mainstream society, rather than be taken care of in institutions outside society. This might be cheaper too. Hence policy measures were taken to accomplish deinstitutionalization. This article discusses the implications of deinstitutionalization for distributive justice. It is argued that the weakest among the weak and fragile stand to lose from this operation. For able bodied citizens deinstitutionalization entails a move from passive to active solidarity. Rather than just pay taxes they have to actively care for and help the needy themselves. The move from passive to active solidarity tends to take advantage of benevolent citizens and burden the socioeconomically disadvantaged. This may be a reason to reconsider the policy move toward deinstitutionalization.
传统福利国家建立在消极团结的基础之上。身体健康、心智健全的公民缴纳税款和社会保险费，通常遵循依据支付能力原则的累进税制逻辑。老年人、体弱多病者、残疾人在机构中得到照料，这些机构通常位于乡村的宁静地区（山区、林区、海边）。在20世纪80年代和90年代，观念发生了变化。专业人士、患者和政策制定者认为，弱者和脆弱人群生活在主流社会中会更好，而不是在社会之外的机构中得到照料。这样做或许成本也更低。因此，政府采取了政策措施来实现去机构化。本文讨论了去机构化对分配正义的影响。有人认为，最弱势和最脆弱的群体可能会因这一举措而受损。对于身体健康的公民而言，去机构化意味着从消极团结转向积极团结。他们不再只是缴纳税款，而是必须亲自积极照顾和帮助有需要的人。从消极团结到积极团结的转变往往会利用善良公民的力量，给社会经济上处于不利地位的人带来负担。这可能是重新考虑去机构化政策举措的一个理由。
