Waitzkin H
Ann Intern Med. 1983 Feb;98(2):235-42. doi: 10.7326/0003-4819-98-2-235.
Social contradictions, including uneven economic development and the private-public duality, make community-based provision of health care difficult. The unrestricted expansion of private medical centers has been criticized from several perspectives including inadequate coordination of services, high costs, and negative effects on urban housing and living conditions. Corporate and professional control over health policy, monopolization, and public subsidization foster expansion of private institutions. While private facilities enlarge, public health-care institutions deteriorate, close, or shift to private management. Many clients eligible for care at public hospitals do not receive adequate attention in the private sector. Despite their achievements, community clinics have problems that threaten their survival. The financial insecurity of community clinics is an inherent feature of the private-public duality that affects the entire health-care system. Community clinics and public hospitals offer a potential for broader organizing and empowerment.
社会矛盾，包括经济发展不均衡以及公私二元性，使得以社区为基础提供医疗保健变得困难。私人医疗中心的无节制扩张受到了多方面批评，包括服务协调不足、成本高昂以及对城市住房和生活条件产生负面影响。企业和专业人士对卫生政策的控制、垄断以及公共补贴助长了私人机构的扩张。随着私人医疗机构的扩大，公共医疗机构则恶化、关闭或转为私人经营。许多有资格在公立医院接受治疗的患者在私立部门得不到充分关注。尽管社区诊所取得了一定成绩，但它们也面临着威胁其生存的问题。社区诊所的财政不安全是影响整个医疗保健系统的公私二元性的固有特征。社区诊所和公立医院具有进行更广泛组织和赋权的潜力。
