Rotarou Elena S, Sakellariou Dikaios
University of Chile, Department of Economics, Diagonal Paraguay 257, Office 1506, Santiago, 8330015, Chile.
Cardiff University, School of Healthcare Sciences, Eastgate House, Newport Road 35-43, Cardiff, CF24 0AB, United Kingdom.
Health Policy. 2017 May;121(5):495-503. doi: 10.1016/j.healthpol.2017.03.005. Epub 2017 Mar 16.
The aim of this article is to discuss how neoliberal policies implemented in the Chilean health system during the Pinochet regime have a lingering effect on equal access to health care today. The two-tier health system - public and private - that was introduced in the early 1980s as a means to improve efficiency and lower health-related costs, has led instead to inequality of access and dehumanisation of health care. Health has changed from being a right to being a marketable need, thus creating a structural disadvantage for several parts of the population - particularly the poor, the elderly, and women - who cannot afford the better-quality services and timely attention of private health providers, and thus, are not adequately protected against health risks. Despite the recent health reforms that aim at improving equity in health care access and financing, we argue that the Chilean health system is still biased against the poorer segments of the population, while it favours the more affluent groups that can afford private health care.
本文旨在探讨皮诺切特政权时期在智利卫生系统实施的新自由主义政策如何对如今平等获得医疗保健产生持久影响。20世纪80年代初引入的公私两层卫生系统，本是提高效率和降低医疗相关成本的手段，却反而导致了获得医疗服务的不平等以及医疗保健的非人性化。健康已从一项权利变成了一种可交易的需求，从而给部分人群——尤其是穷人、老年人和妇女——造成了结构性劣势，他们无力承担私立医疗服务提供者提供的质量更高的服务和及时护理，因此无法得到充分的健康风险保护。尽管最近的卫生改革旨在改善医疗保健获取和融资方面的公平性，但我们认为，智利卫生系统仍然对较贫困人群存在偏见，而偏袒那些能够负担得起私立医疗保健的较富裕群体。
