Saltman Richard B
Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA USA.
Isr J Health Policy Res. 2015 Apr 17;4:5. doi: 10.1186/2045-4015-4-5. eCollection 2015.
Although the concept of solidarity sits at the center of many European health sector debates, the specific groups eligible for coverage, the financing arrangements, and the range of services and benefits that, together, compose the operational content of solidarity have all changed considerably over time. In prior economic periods, solidarity covered considerably fewer services or groups of the population than it does today. As economic and political circumstances changed, the content of solidarity changed with them. Recent examples of these shifts are illustrated through a discussion of health reforms in Netherlands, Germany and also Israel (although not in Europe, the Israeli health system is similar in structure to European social health insurance systems). This article suggests that changed economic circumstances in Europe since the onset of the 2008 financial crisis may lead to re-configuring the scope and content of services covered by solidarity in many European health systems. A key issue for policymakers will be protecting vulnerable populations as this re-design occurs.
尽管团结的概念是许多欧洲卫生部门辩论的核心，但随着时间的推移，有资格获得保险的特定群体、筹资安排以及共同构成团结运作内容的服务和福利范围都发生了很大变化。在过去的经济时期，团结所涵盖的服务或人口群体比现在要少得多。随着经济和政治环境的变化，团结的内容也随之改变。通过对荷兰、德国以及以色列（尽管以色列不在欧洲，但其卫生系统在结构上与欧洲社会医疗保险系统相似）卫生改革的讨论，可以说明这些转变的最新例子。本文认为，自2008年金融危机爆发以来，欧洲经济环境的变化可能导致许多欧洲卫生系统中团结所涵盖服务的范围和内容重新配置。在进行这种重新设计时，政策制定者面临的一个关键问题将是保护弱势群体。
