" REFORMING HEALTH CARE: The Philosophy and Practice of International Health Reform (1995)”, edited by Seedhouse describes a detailed account of practical health reforms in different countries; including Health reform in the US, UK, New Zealand, Eastern Europe and South Africa with the aim of knowing what is happening in different health care systems and how they try to reform those health systems. The author highlights the inefficiencies of health reforms occurring in different countries, largely due to negligence of key aspects of health reform process. One such key aspect is the philosophical basis of health reform.
It basically states the importance of considering the philosophical questions and aspects when planning for health reform. It applies philosophical analysis to problems of heath services policy and practice so as to understand the health reform better and to play a small part in resolving existing reform associated problems.
The first argument of the author is that the reforms which are done in most countries are practical reforms in and are lacking universal coverage in terms of health needs of the community. The Heath care systems in some countries segregate people on which type of heath care should one get, mainly due to rising costs of health care and racism (South Africa and Lithuania). Otherwise the heath care is inefficient in-terms of quality, availability, and priorities. Individual and institutional racism, along with the stigma of inferiority, can adversely affect health for minorities. Racism can also directly affect health in multiple ways. Residence in poor neighborhoods, racial bias in medical care, the stress of experiences of discrimination and the acceptance of the societal stigma of inferiority can have deleterious consequences for health.
The author also points the second argument of the negligence of community participation in the process of Heath reform process in some countries (Netherlands for instance and South Africa).
The third argument of the author is on how to do a better reform process. To study and understand Heath Reform the facts of practical reforms are not enough. A health reform should comprise of the practical health reform, the theory of health and the underlying logic of the reform.
Practical reform should meet the following conditions: The area of activity which is to be reformed must be delineated; the originally desired overall purposes of the delineated activities must be known (even if the activities are not presently achieving the desired purposes); it must be clear why the existing set-up is not achieving the desired overall purposes or if achieving the desired purposes why with disadvantages; the strategies of undertaking the reform must be known and possible. It must be clear how the intended reforms will ensure that the desired overall purposes will be better achieved; and the originally desired overall purposes should not be abandoned because to do this would not be to reform but to implement the radical changes.
Philosophical aspects should be addressed in details. The philosophy represents the values, believes and the commitments and aspiration of the Heath reform. Both practical issues and social philosophy are connected by a well-formulated theory of heath promotion. The theory sets clear limits(borders beyond which it does not apply),says what the goals of health work are and how the process of heath work are compatible with, and can actually produce health as defined by the theory. Practical issues should go parallel with social philosophy.
The philosophy of the Heath reform therefore serves as a guide of how the reform should be conducted. The responsibilities of the philosophy include assuring the satisfaction of both the patients and medical suppliers; give the stakeholders a reasonable return on investments; offers the patients good medical care and services at competitive prices; and understanding the impact the Heath reform may have on society in order to avoid negative effects and enhance positive ones.
In summary in reforming Heath Care it is therefore important to be guided by important ideas: the meaning of heath reform; the goals of heath reform process; and the criteria for assessing success and failure of health reform process. It only by understands the logical structure of reform that the reform can be done much better. Although philosophy has much to contribute to heath reform its advantages are rarely appreciated by heath care policy-makers. Study of Heath reforms in some countries makes it clear that many reformers have undertaken only minimum of philosophical reflection, if they have done any at all.