Lüschen G, Niemann S, Apelt P
Department of Sociology, University of Alabama, Birmingham 35294, USA.
Soc Sci Med. 1997 Mar;44(6):883-99. doi: 10.1016/s0277-9536(96)00193-1.
This is an analysis of system integration, social stratification and work for health status and health care in East and West Germany. It is based on aggregate data and representative survey data of random samples of 2554 adults in both subsystems. Findings show that there were marked differences in life-expectancy prior to unification. The integration of the two systems, which occurred almost totally with regard to terms of West German health care organization, shows adjustment problems in the East for the public Health-Care-Funds and few if any for ambulatory care. The work situation has an impact on health, but there are no significant differences for East versus West. Social stratification variables show an influence on subjective health status for education (East) and for income, social status (West), while physician utilization (despite a preference of specialists by those with higher status) is not significantly determined by stratification variables in either East or West Germany. Beyond the central focus on work and stratification determinants a major finding pertains to a comparatively worse health situation for the aged and for women in what was the former East Germany. System models of Capitalism versus Socialism fit the results and recent history of the two systems to only a limited degree, as the West German corporate health system shows clear limits in following free market principles. The East German system, regardless of its centralized organization and move towards a socialist system, never fully abandoned the traditional model of German health care. Unlike the East German health system, that of West Germany, with its general expansion to 92% of the population, shows an increasing effect for social redistribution. The latter may be a reason why standard indicators of social stratification show less of an impact on health and health care than expected, while conditions at work clearly determine the health of people-the latter being the case in both the former East and West Germany.
这是一项关于东德和西德的系统整合、社会分层以及健康状况与医疗保健工作的分析。它基于两个子系统中2554名成年人随机样本的汇总数据和代表性调查数据。研究结果表明，统一前预期寿命存在显著差异。两个系统的整合几乎完全按照西德医疗保健组织的模式进行，这在东德的公共医疗保健基金方面显示出调整问题，而门诊护理方面问题较少。工作状况对健康有影响，但东西德之间没有显著差异。社会分层变量对主观健康状况的影响体现在教育（东德）以及收入、社会地位（西德）方面，而医生利用率（尽管地位较高者更倾向于专科医生）在东德或西德都没有显著地由分层变量决定。除了对工作和分层决定因素的核心关注之外，一个主要发现是，在前东德地区，老年人和女性的健康状况相对较差。资本主义与社会主义的系统模式仅在有限程度上符合这两个系统的结果和近期历史，因为西德的企业健康系统在遵循自由市场原则方面存在明显局限。东德系统尽管其组织集中并朝着社会主义系统发展，但从未完全摒弃德国传统的医疗保健模式。与东德健康系统不同，西德的健康系统覆盖了92%的人口，显示出越来越大的社会再分配效应。这可能是社会分层标准指标对健康和医疗保健的影响低于预期的一个原因，而工作条件显然决定着人们的健康——在前东德和西德都是如此。
