Universal Health Care Systems (UHCS) on the Periphery of Capitalism

Hans-Ulrich Deppe, MD

Professor for Medical Sociology and Social Medicine

J.W. Goethe-University of Frankfurt/ Germany

[email protected]

X Congreso Latinoamerikano de Medicina Social, IV Congresso Brasileiro de Ciencias Sociais e Humanas em Saude, XI Congress of the International Assotiarion of Health Policy , Equidade, Etica e Direito a Saude: Desafios a Saude Coletiva na Mundializacao vom 12. bis 18. Juli 2007 in Savador de Bahia/ Brasilien

To speak about UHCS on the periphery of capitalism in this general form is not easy. The countries on the periphery of capitalism are different. I want to outline some questions and problems with thesis.

1. Health care systems in general are always determined by the structure and development of a country. Health care systems are not isolated social constructions. They are rooted deeply in the structure, the culture and the history of their societies. They are embedded in a society. They are often one pre-condition for social peace inside contradictory societies. In opposite to the increasing globalisation of capital health care systems are strongly connected with the national states. The transformation of health care systems implies more than mere technological changes. The structural change of health care systems is always the result of social and political struggles. Often it is the result of the social compromise between capital and labour - especially in times of social and political crises. This means that a special health care system has to be fought for. In the history in many parts of the world health care systems changed structurally after revolutions and wars, after the defeat of fascist and military dictatorships or after the collapse of the socialist countries. And the struggle for a health care system is not a single action but it is a permanent fight. A health care system is the mirror of a society. It reflects its history and its character. Because of that every country needs to develop its own health care system.

An empirical example fort this is the difficult current process in the European Union which follows the formula: Economic/currency union – political union – social union.

2. Before we go on it makes sense to explain what I understand under universal health care systems.

Universal health care is characteristic for a health care system in which all residents of a country have access to health care, regardless of medical condition. Medicine in UHCS is orientated to the need – to that what is medically necessary. The majority of universal health systems are funded primarily by tax revenues (like in Denmark, Sweden or Canada.) If universal health care systems are funded primarily by taxes we have to look exactly how the national tax policy is structured and who will be favoured or discriminated by it. We have to look if it is based on solidarity or if it supports social privileges. Other nations (like Germany, France or Japan) have a universal health care system in which health care is funded by private and public contributions. Universal health care systems vary in what services are covered completely, covered partially, or not covered at all.

3. UHCS on the periphery of capitalism have different histories:

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