title: [Failures, problems and hopes in the transformation of health services. 2. Dilemmas in the development of health services].
abstract: In the second stage of the reform it is essential to proceed from problems of financing and rewards to health services and their ethic attributes. The dilemma produced by the increasing demands on availability and standard of services on the one hand and efforts to reduce costs on the other leads to the metaphorical "iron triangle of health care", exposed to intense internal tension. The only possibility how to straighten it, which would weaken the danger of crisis, are strict regulatory measures enforced by the State. The foremost task is to define and specify basic (standard) care. As a possible approach the author mentions the Oregon experiment. He draws attention to the phenomenon of "concentration of costs" in the practice of health insurance companies, calling for a major measure of solidarity.
authors.affiliation: Ustav sociáiního lékarství a verejného zdravotnictví LF MU v Brnĕ.
authors.forename: A
authors.initials: A
authors.lastname: Zácek
mesh_terms: D018153:Czech Republic; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D018166:Health Care Reform; D005102:Health Expenditures; D011787:Quality of Health Care