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Pluralism, Public Choice, and the State in the Emerging Paradigm in Health Systems
Author(s) -
Chernichovsky Dov
Publication year - 2002
Publication title -
the milbank quarterly
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 101
eISSN - 1468-0009
pISSN - 0887-378X
DOI - 10.1111/1468-0009.00002
Subject(s) - entitlement (fair division) , capitation , equity (law) , health care , business , public economics , state (computer science) , public fund , pluralism (philosophy) , public relations , public administration , economics , political science , economic growth , law , philosophy , epistemology , computer science , mathematical economics , algorithm
T he conceptualization of medicine as a unique field of endeavor is swiftly changing, and the change involves complex social and technological factors. The concept of “medicine” is dynamic: the range of ailments dealt with by medical care changes, as does the range of therapeutic options. In addition, with the growth in income and education, consumers—especially those in the middle‐ and upper‐income brackets who are self‐reliant and stress individualism—expect an increasing diversity of medical care and ins‐titutions to supply it (Antonovsky 1987; Schneider, Dennerlein, Kose, et al. 1992; Williams and Calnan 1996). Hence, the character of the product or service offered and demanded is becoming more difficult to determine, especially in socioeconomically advanced communities. In developed nations, the absence of a correlation between a country's expenditures on medical care and the population's health as measured by morbidity and mortality complicates the issue further, since the association between health and the level of investment in medical care is not always as might be expected (OECD 1990).