The Milbank Memorial Fund quarterly. Health and society
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Milbank Mem Fund Q Health Soc · Jan 1980
The double-edged sword: paternalism as a policy in the problems of aging.
Paternalism--coercive or deceptive interference in a citizen's life for his own good--is much in evidence in our policies regarding the aged. Some argue that paternalism is an unwarranted denial of individual liberty, ,for doubtful societal gain. Others contend that freedom has but instrumental value, and the aged cannot always use it effectively to aid in pursuit of their own happiness. The philosophical and political choices made on behalf of the aged must be understood as imperfect compromises.
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American and British reformers may act as if reducing the number of beds alone reduces human distress or the incidence and prevalence of psychiatric illness. Deinstitutionalization requires a recognition of changed relationships between patients and staff, and between patients and families. Our two cultures have responded differently to questions of where, by whom, and how to treat their mental patients.
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The premises underlying our understanding of the nature of mental illness and its treatment are subject to cycles of fashion. Recurring emphasis is too often on structures and too seldom on functions within a system. Publicizing paradigms is no substitute for demonstration of efficacy.
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Milbank Mem Fund Q Health Soc · Jan 1975
Equity in paying for health care services under a national insurance system.
The debate over the future of the health care delivery system evolves around the policy issue of what constitutes a fair distribution of the medical services which are considered essential to prolonging life, curing disease, and relieving pain. A case can be made that a socially equitable distribution implies that consumption of medical services is independent of the consumer's income and payment for them unrelated to utilization. The present paper examines to what extent the provisions for financing a national health insurance system are likely to advance or hinder the fair distribution of health care services. ⋯ To rectify such inequities, some NHI proposals specify separate insurance plans for the disadvantaged. Such programs, which require income-testing to determine eligibility, are likely to be plagued by administrative complications currently engulfing other means-tested social welfare programs. The present paper makes some recommendations for the purpose of avoiding these difficulties and fostering equity in health care.