Health sector reform.

نویسنده

  • D Haran
چکیده

No one is too clear about the underlying goals of health sector reforms. The cynical may detect a neo-liberal free market agenda in the rhetoric that emanates from the World Bank’s health report of 1993, but even the cynical need to deal with the issues that health reforms throw up. More recently the Bank itself has recognised the failures of the market approach in health care and argued for a greater involvement of the state in the health sector. What are the appropriate goals for public authorities and for the state in reforming the health sector, and is there any consensus on these goals? The health sector reform work programme underway at Liverpool School of Tropical Medicine has outlined some possible goals: health gain, by curative and preventive care; equity, by fair distribution of benefits provided by society and the state; social care, by looking after those who cannot be cured; insurance, by protecting individuals and households against health care costs; and the national economy, by ensuring a healthy workforce. There is no consistently applied, universal package of measures that constitutes health sector reform. Rather, the precise agenda for reform will be defined by reviewing how well existing policies, institutions, structures, and systems deal with issues of eYciency, access, cost containment, and responsiveness to popular demand. The relative importance of these issues will vary between less developed countries, industrialised countries, and countries in transition from a command economy. In less developed countries, reform strategies need to address the issues of extending the coverage of basic services to under-served populations, improving poor service quality, and addressing the inequitable distribution of resources, in the context of very limited institutional capacity. In many of the world’s richer countries cost containment has been the driving force behind reform. However, the need for systems to ration health care provision in line with national policy objectives is common to all countries. Each country has its own agenda for health sector development, but three broad policy objectives usually feature.

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عنوان ژورنال:
  • Journal of epidemiology and community health

دوره 52 12  شماره 

صفحات  -

تاریخ انتشار 1998