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自由市场资本主义是否导致健康机会不平等?1970-2015 年的实证分析。

Does free-market capitalism drive unequal access to health? An empirical analysis, 1970-2015.

机构信息

Institute for Sociology & Political Science (ISS), Norwegian University of Science & Technology (NTNU) Trondheim, Norway.

School of Politics & International Relations (SPIRe), University College Dublin (UCD), Newman Building, Belfield, University College Dublin (UCD), Dublin, Ireland.

出版信息

Glob Public Health. 2021 Dec;16(12):1904-1921. doi: 10.1080/17441692.2020.1849350. Epub 2020 Nov 30.

Abstract

Many scholars, particularly in public health, argue that neoliberal capitalist economic forces adversely affect communities by increasing inequalities, ultimately affecting health. Apparently, corporate capitalism affects health and communitarian concerns because governments place corporate profits over the publićs interests. Using unique data collected by the Varieties of Democracy (VDEM) project that capture the degree of access of the poorest segments of society to health services comparable with those available to the richest segments, this study finds that an index of economic freedom robustly reduces inequality of access to health. We argue that these results obtain because greater exposure to global markets increases the premium on the productivity of labour, increasing incentives for political elites to invest in productivity-enhancing public goods. Our results are robust to a number of alternative models and data, and robust to instrumental variables analyses addressing potential endogeneity. Rather than free-market capitalism increasing health-related neglect of society, our data suggest that free-market capitalist conditions promote equitable access to health. This is good news for governments wishing to grow their economies, reform broken health systems for gaining advantages in a competitive global economy, and serve communitarian interests, such as shared good health.

摘要

许多学者,尤其是公共卫生领域的学者,认为新自由主义资本主义经济力量通过加剧不平等,最终影响健康,对社区造成了不利影响。显然,由于政府将企业利润置于公众利益之上,企业资本主义影响了健康和社区的利益。本研究利用多样性民主(VDEM)项目收集的独特数据,这些数据捕捉了社会最贫困阶层获得与最富裕阶层相当的医疗服务的机会程度,发现经济自由指数有力地降低了获得医疗服务的不平等程度。我们认为,这些结果之所以成立,是因为更多地接触全球市场提高了劳动力生产力的溢价,增加了政治精英投资于提高生产力的公共产品的动机。我们的结果在许多替代模型和数据中是稳健的,并且对解决潜在内生性的工具变量分析也是稳健的。我们的数据表明,自由市场资本主义并没有增加对社会的与健康相关的忽视,而是促进了公平获得医疗的机会。对于希望发展经济、改革在竞争激烈的全球经济中获得优势的破碎医疗体系以及为社区利益服务(如共同健康)的政府来说,这是个好消息。

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