查看文章

Reforms that have swept across health care systems worldwide in recent decades, profoundly affecting how health care is financed and delivered, have also challenged long-held notions about the appropriate roles of the State and the market. From the first half of the 19th century, governments began to play a more active and direct role in protecting and promoting public health. Epidemics during the industrial revolution, spread by migration, trade and conflict, led to the adoption of new public policies to address water and sanitation, housing, nutrition and working environments. During the 20th century, the State grew to play an even bigger role in many countries, including the creation of national health systems (Lee 2003). The unprecedented improvements in health status since the early 1900s have largely been due to these efforts to address the broad determinants of health (Sen and Bonita 2000). Health sector reforms sweeping the globe since the 1980s have again raised the question of the appropriate role of government. Initial reforms shifted many health systems back towards a more “minimalist” state in terms of health financing and service provision. Since the mid-1990s, the ideological pendulum has begun to swing back again towards recognition that governments must invariably play a lead role in providing certain essential functions. The challenge facing all societies today is defining and agreeing what essential functions governments must provide to best protect and promote health. This chapter examines the role of government in providing effective responses