Suchergebnisse

The rising cost of health care in Western European countries is now seen by many governments as a problem, and attempts are being made to find a solution by introducing cost‐containment policies.The author begins by reviewing trends in health care expenditures, and examines some of the underlying reasons for the upward trend.He then considers some of the more important differences in the organization and financing of Western European health care systems, before surveying the different kinds of cost‐containment policies which are being, and could be, pursued.The conclusion is that present cost‐containment policies do not take sufficiently into account the underlying reasons for rising costs, and that the criteria for evaluating the success of these policies are inadequate. To be successful, the policies will have to be altered, and the objectives and means of evaluation reconsidered.

SUMMARY Improvements in health among the populations of developed countries have come about largely through improved living standards and public health measures, and the contribution of medicine has been relatively small. In addition, many medical techniques of the present have not yet been evaluated. A health policy giving due weight to broad social measures is applicable to both developed and underdeveloped countries, but this may involve change in underlying socioeconomic structures and so encounter political obstacles.RESUMEN Salud y sociedad: reflexiones sobre polḱticaLos progresos en salud registrados en los países desarrollados, derivan principalmente de mejoramientos en los niveles de vida y de medidas de salud pública, siendo relativamente pequeña la contribución de la medicina. Por otra parte, muchas de las técnicas médicas actuales no han sido evaluadas hasta ahora. Una política de salud que otorgue el debido peso a amplias medidas sociales, es aplicable tanto a los países desarrollados como a los subdesarrollados. No obstante, esto puede involucrar cambios en las estructuras socioeconómicas subyacentes y, en concecuencia, encontrar obstáculos políticos.RESUMES Santé et société: réflections sur le systèmeL'amélioration de la santé chez les populations des pays développés se doit, en grande partie, à un meilleur niveau de vie et aux mesures plus appropriées introduites par la santé publique, la médecine même n'y ayant joué qu'un rôle relativement minime. De plus, beaucoup de techniques médicales actuelles n'ont pas été adéquatement évaluées. Un programme de santé qui prend en juste considération l'ensemble des intérêts sociaux, serait applicable aussi bien pour les pays développés que sous‐développés, mais ceci peut entraîner un changement fondamental des structures socio‐économiques et rencontrer par conséquent des obstacles politiques.

SUMMARYThe paper argues that the problem of obesity can usefully be seen as illustrating a new kind of market failure. At the heart of such failures is the emergence of a sub‐optimal choice environment which, though derived from a large number of small individual optimising decisions, is not the choice environment that people would choose if they were able to choose the environment itself. This idea is claimed to be consistent with modern economic theories of freedom of choice and applicable particularly to choice environments that emerge in highly competitive market situations. The retail supply of food and consumer credit is discussed by way of example. Concluding, the paper develops the concept of a 'deliberative economy' as an alternative to liberal paternalism and explores conditions under which such an approach to social choice might deliver desirable outcomes.

Recent years have witnessed a growing concern in the NHS to devise and implement policies which explicitly recognise that certain client groups and services should receive a higher priority. The paper points to problems arising from the formulation and implementation of the Scottish health priorities documents, drawing where appropriate on related developments in England. Three areas are highlighted for analysis: the policy ambiguity inherent in the documents; problems of collaboration in implementing the policies; and problems posed by central-local relations. The paper concludes that there is a need for a more sophisticated response to the present fiscal squeeze than simply defending the status quo and suggests that the squeeze could provide the necessary stimulus for change.