The LSE Companion to Health Policy
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The LSE Companion to Health Policy

Edited by Alistair McGuire and Joan Costa-Font

The LSE Companion to Health Policy covers a wide range of conceptual and practical issues from a number of different perspectives introducing the reader to, and summarising, the vast literature that analyses the complexities of health policy. The Companion also assesses the current state of the art.
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Chapter 3: Socioeconomic Status and Access to Health Care: The Quandary of Transition Economies

Heba A. Elgazzar


Heba A. Elgazzar 1. INTRODUCTION To sustain quality social environments with diminished resources is a difficult task. It is possible that societies with high quality social capital will be better able to adjust than will fragmented individualistic societies. Societies that have a strong, coherent sense of what is important, and a collective will, will probably be most successful. (Frank and Mustard, 1994, p. 17) Emerging studies on income inequality point to a paradox. Despite economic progress, social inequalities such as disparities in wealth and health appear to be widening in many countries (Coburn, 2003). In the case of health, various economic barriers to accessing health care services may exist, such as a low ability to pay and a lack of access to safety nets. This chapter examines the relationship between economic status and the utilisation of health care services in middle-income countries. Social values help to shape the debate on how health care should be organised and financed, as well as the role of the state. Where the health care system is oriented towards social solidarity, the state tends to play a more active role in ensuring that all socioeconomic levels have equal access to services regardless of ability to pay. In transition economies such as middle-income countries in the Middle East, Latin America, Eastern Europe and Southeast Asia, governments are currently in the process of building institutional effectiveness, reducing corruption and strengthening overall governance. Health systems are often bimodal, where public and private systems operate in parallel and are...

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