Vågerö D
Swedish Institute for Social Research, Stockholm.
Soc Sci Med. 1994 Nov;39(9):1203-10. doi: 10.1016/0277-9536(94)90352-2.
Health care reform in both eastern and western Europe is on the agenda, and in both parts of Europe the importance of equity targets has been questioned. In the East, the previously strongly held equity goals were largely a facade, covering all sorts of privilege systems, something which has brought equity as a concept into disrepute. However, present developments mean that it is quite likely to be back on the agenda again soon. In the West, equity has been seen as inevitably linked to non-market systems of health care. In moving towards market solutions equity has come to be seen as conflicting with efficiency goals. This contra-positioning of equity and efficiency does not stand up to critical examination. It is based on confusing strategic goals with the implementation of those goals. Equity could be seen as a strategic goal in its own right. We may ask what are the most efficient ways of financing, managing and delivering medical services to achieve that goal. Clearly this has not been the question on the agenda. Cost containment has been imperative, and the consequences for general health, equity in health or the health and care for those suffering most, has been relegated to second place. The reduction of inequalities in health can be seen as an overall strategy for the improvement of a population's health, and as helpful in the maintaining and improvement of its human capital.(ABSTRACT TRUNCATED AT 250 WORDS)
东欧和西欧的医疗改革都已提上日程，而且在欧洲这两个地区，公平目标的重要性都受到了质疑。在东欧，以前坚定持有的公平目标很大程度上只是一种表象，掩盖了各种特权体系，这使得公平作为一个概念声名狼藉。然而，目前的发展态势意味着它很可能很快会再次被提上议程。在西欧，公平被视为不可避免地与非市场医疗体系相关联。在转向市场解决方案的过程中，公平已被视为与效率目标相冲突。这种公平与效率的对立经不起批判性审视。它是基于将战略目标与这些目标的实施相混淆。公平本身可以被视为一个战略目标。我们可能会问，为实现该目标，融资、管理和提供医疗服务的最有效方式是什么。显然，这并非议程上的问题。成本控制一直是当务之急，而对总体健康、健康公平或最弱势群体的健康与护理所产生的影响则被置于次要地位。减少健康方面的不平等可以被视为改善民众健康的总体战略，并且有助于维持和提升其人力资本。（摘要截选至250词）
