220 IUNES
Any view or model of the organization/reorganization of the health sector reflects in general a conception of the state and reflects in particular a conception of a social welfare function within that state. Health reforms are means to achieving the goals described by the social welfare function chosen by a particular country. As such, health reforms should be implemented on the basis of their capacity to achieve or maximize the given society's values and goals. Unfortunately, many reform proposals fail to embody a recognition of this distinction and are implemented instead as if they were ends in themselves. In fact, the detachment between means and goals is one of the main reasons for the difficulties faced by those entrusted with implementing these reforms. The relationship between means and goals implies that any proposal aimed at reorganizing the health sector will not be value free. In this sense, external technical and financial assistance should be limited to supporting the recipient country in the selection of the alternative that is technically best suited for achievement of that country's own particular social desideratum. The experiences of health system reorganization in Latin America and the Caribbean have demonstrated that there really exist no infallible general formulas or solutions to be followed. Even those measures for which there seems to exist some general technical consensus are not options without risks or costs. Those working in the health sector must accept the fact that health system reorganization is ultimately a social experiment in progress, for which many of the answers are simply not yet available. The understanding of these limitations will help to minimize false expectations and will therefore help also to increase the likelihood that the main goals of health system reorganization will indeed be achieved.
References Health Insurance Association of America. 1966. Managed Care: Integrating the Delivery and Financing of Health Care. Washington, D.C.: Health Insurance Association of America. Matus R., Carlos. 1977a. Planificacion de situaciones. CENDES. Caracas: Libros Alfar. . 1977b. Estrategia de la transformation social. Caracas: CENDES.
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Final Reflections and Conclusions