Markets, information asymmetry and health care: Towards new social contracts
Markets, information asymmetry and health care: Towards new social contracts
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DOI：
10.1016/j.socscimed.2008.01.034
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发表时间：
2008-05-01
影响因子：
5.4
通讯作者：
Lloyd, Robert
中科院分区：
文献类型：
--
作者：
Bloom, Gerald;Standing, Hilary;Lloyd, Robert
本文探讨了非正式和正式市场在许多低收入和中等收入国家卫生系统中日益增强的作用的影响。它侧重于制度安排，以在面对医疗保健的信息不对称的情况下，广泛提供专业医学知识的好处。它认为，社会安排可以被理解为行为者之间的社会契约，以共同的行为规范为基础，并嵌入更广泛的政治经济中。这种契约是通过各种行为者和机构表达的，而不仅仅是通过卫生部门的正式人员和安排。这种理解意味着新的制度安排，例如基于声誉的信任机制的传播，可以从社会和经济的其他部分出现或适应。本文探讨了卫生系统的三个关系方面：患者和提供者之间的接触；在高度市场化的体系中建立对商品和服务的信任的机制；以及建立社会合法的监管制度。本分析用于回顾一些低收入和转型国家的卫生系统创新和变革经验。 (C) 2008 Elsevier Ltd. 保留所有权利。
This paper explores the implications of the increasing role of informal as well as formal markets in the health systems of many low and middle-income countries. It focuses on institutional arrangements for making the benefits of expert medical knowledge widely available in the face of the information asymmetries that characterise health care. It argues that social arrangements can be understood as a social contract between actors, underpinned by shared behavioural norms, and embedded in a broader political economy. This contract is expressed through a variety of actors and institutions, not just through the formal personnel and arrangements of a health sector. Such an understanding implies that new institutional arrangements, such as the spread of reputation-based trust mechanisms can emerge or be adapted from other parts of the society and economy. The paper examines three relational aspects of health systems: the encounter between patient and provider; mechanisms for generating trust in goods and services in the context of highly marketised systems; and the establishment of socially legitimated regulatory regimes. This analysis is used to review experiences of health system innovation and change from a number of low income and transition countries. (C) 2008 Elsevier Ltd. All rights reserved.