Education And Debate

Health care systems for the 21st century

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7091.1407 (Published 10 May 1997) Cite this as: BMJ 1997;314:1407
  1. Seventh Consultative Committee on Primary Health Care Systems for the 21st Century
  1. Correspondence to: Paul Ress health correspondent, 22 Chemin Briquet 1209, Geneva

    Introduction

    Health services in many countries are in turmoil. The abrupt shift to a market approach taken by many governments has given rise to the notion that health is just another commodity to be bought and sold. It was against this background of upheaval that the World Health Organisation recently held a meeting on health systems for the 21st century. At the heart of the conference were two questions. “What will the challenges be in the 21st century?” and “How will they affect the organisation and functioning of future health services and systems?” The meeting of the Seventh Consultative Committee on Primary Health Care Systems And Services for the 21st Century brought together health professionals from many developed and developing countries, such as Mexico, Britain, South Africa, and the Republic of Korea. Their findings have far reaching implications for WHO's 191 member states and the committee decided to summarise their conclusions to facilitate widespread dissemination and discussion.

    The change to a market approach

    Health systems worldwide have failed to recognise the fundamental change in the world that has come to dominate economic and social development over the past decade. This model can be paraphrased as “the market approach.” It poses a number of basic challenges to the World Health Organisation's long term strategy of Health For All. One of these challenges is the notion that health is merely a commodity and, as such, has a price. It can be traded off against other commodities.

    At the same time there is a growing acknowledgement that good health is a prerequisite for human development and for maintaining peace and security, without which economies cannot thrive. In the face of this contradiction health systems have adopted an approach characterised by passive reaction. In the public sector reduced budgets for health have been condoned while poverty and inequalities in access to …

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