Anh ngày càng bị các hậu quả của riêng mình: phát triển lâm nạn xã hội, cảnh thiếu thốn của giai cấp công nhân, dịch bệnh và tỷ lệ tử vong cao tại các trung tâm công nghiệp tàn nhẫn. Trong một thời gian dài, | 22 PSYCHIATRY IN SOCIETY Britain were increasingly suffering from their own consequences growing social distress destitution of the working class and epidemics and high mortality rates in the centres of merciless industrialization. For a long time state action in the health care field was limited to providing rudimentary health and social care for the poor. It was not until a total change of system occurred with the introduction of the National Health Service in 1948 that this tradition of radical liberalism came to an end in Great Britain. The ideology of unlimited liberalism has survived in the USA although not without undergoing several small-scale reforms. Almost 75 of the US population have to pay for the treatment and consequences of ill health out of their pocket or by prepaid fees to private insurance schemes. The government insurance schemes such as the Veterans Administration Medicare and Medicaid provide mostly only partial health benefits to limited sections of the population such as former service personnel the elderly and the poor. Vast groups at risk especially the chronically mentally ill go unprotected with a risk of financial and social ruin in case of severe continued illness. In the past two decades with the aim of controlling or reducing costs in this the world s most expensive health care system a managed care system with private-enterprise health maintenance organizations HMOs was established in the USA. The HMOs which make contracts with employers physicians hospitals and other health services provide comprehensive health benefit plans for the employees of large companies and also of individual states. This market-oriented system which has led to serious problems in mental health care we will come back to them later has become a model for a stepwise reform of the health care system in many countries and for bringing private-enterprise elements into state-run or solidarity-based health care systems. Against the background of this brief .
