[Necessary and desirable future emphasis in social medicine from the theoretical viewpoint]

Social medicine, like medicine as a whole, is based on biomedical science and has responsibilities in clinical care, at the same time linking the health system, an important element in the welfare state, to society. Social medicine investigates and expands the scientific basis for securing and promoting health by way of social action, sharing common roots with public health. In the biomedical sphere, emphasis is on improving our understanding of the biological foundations of social behaviour; scanning and assessing the ethical, legal, economical and social implications of scientific progress; influencing the social and economic effects of demographic developments, and improving the scientific basis of preventive, styles of living and interventions. In the clinical sphere, the main objectives are to expand such areas as clinical epidemiology and clinical health economics, to assert patients' rights and to promote population-related medicine in the training of doctors. As far as the health care system is concerned, emphasis is on restoring the solidarity concept between the healthy and the sick as the principle of statutory health insurance, and on securing transparency of performance, quality, and cost. A further objective is to encourage more creative management by the health insurance funds by granting freedom of contract. Open public discussion about the rationale of an ethical health care system is required, discussion in which independent experts trained in population-related medicine must play an active part.