Modernizing concepts of access and equity

Former UK Prime Minister Tony Blair once observed that ‘the purpose of the twentieth century welfare state was to treat citizens as equals; the purpose of the twenty-first century reforms must be to treat them as individuals as well’ (Blair, 2002). Emphasis on the individual is evident in recent UK health service policy, which identifies the aims of ‘personalizing services [by] making [them] fit for everyone’s needs. That includes those people traditionally less likely to seek help or who find themselves discriminated against in some way’ (p. 9). ‘The National Health Service needs to give patients more rights and control over their own health and care’ (Department of Health, 2008: 33). The objective of making government funded services responsive to the needs and choices of individuals is characteristic of ‘Third Way’ philosophies. For health services, the Third Way represents a middle path between two polarities. At one extreme, obtaining needed health care is regarded as the responsibility of individuals and families. At the other, health care is delivered by centrally planned, top-down government services. Through the Third Way, governments play a role in facilitating access to needed care, but are respectful of individual autonomy and choice with services being delivered through either public or private providers. The aim is to make health services more consistent with the outlook of modern societies in which individuals are enabled to chart the course of their own lives and there is tolerance of the diversity that flows from individuals’ choices.