in the 1990s reduced the role of the welfare state and gave greater
primacy to the market
The state, as the guarantor
of equity, has become less effective in many countries. Its powers
have been scaled down by deliberate policy measures, by reduced
public spending or by declining performance. The coverage it
gives to the lowest income social groups has fallen at the same
time as poverty has grown.
As a result, many people are
now marginalized from effective services and depend on self-help
2000). Even where the effects have been less extreme, the
state is currently confronted by policy choices over how it implements
core public health principles such as equity, solidarity, risk
pooling and universality in a diverse environment of purchasers,
providers and users of health services.