Resisting privatization and marketization of health care: People’s Health Movement’s experiences from India, Philippines and Europe

Sulakshana Nandi,Chhaya Pachauli,Ana Vračar

doi:10.1590/0103-11042020s103

Abstract

ABSTRACT For the last three decades, healthcare systems have been under pressure to adapt to a neoliberal world and incorporate market principles. The introduction of market-based instruments, increasing competition among health care providers, introducing publicly -funded private sector provisioning of healthcare through health insurance financing systems to replace public provisioning of health care, promoting individual responsibility for health and finally, the introduction of market relations through privatization, deregulation and decentralization of health care have been some common elements seen globally. These reforms, undertaken under the guise of increasing efficiency and quality through competition and choice, have in fact harmed the physical, emotional and mental health of communities around the world and also contributed to a significant rise in inequities in health and healthcare access. They have weakened the public healthcare systems of countries and led to commercialization of healthcare. This article presents three case studies of resistance, to the commercialization of health care, by the People’s Health Movement (PHM) and associated networks. It aims to contribute to the understanding of the way neoliberal reforms, including those imposed under structural adjustment programmes and some promoted under the Universal Health Coverage (UHC) paradigm, have impacted country-level health systems and access of people to health care, and bring out lessons from the resistance against these reforms.

Highlights

For the last three decades, health care systems have been put under great pressure to adapt to a neoliberal world and incorporate market principles
Starting from the early 1980s, international financial institutions – mainly the International Monetary Fund (IMF) and World Bank (WB) – inspired a series of Structural Adjustment Programmes (SAPs) in Low-and-MiddleIncome Countries (LMIC) that were supposed to ease the transition towards a market-driven world
It aims to contribute to the understanding on the way neoliberal reforms, which include those under SAPs and the Universal Health Coverage (UHC) paradigm, have historically impacted country-level health systems and access of people to health care, and to bring out lessons from the resistance to these reforms

Summary

Introduction

For the last three decades, health care systems have been put under great pressure to adapt to a neoliberal world and incorporate market principles. The proposed scenario envisioned the private sector playing a central role in the provisioning of services, with the government mainly playing the leadership, regulation and financing roles[11] This was further cemented in the World Health Report of 200012 through the articulation of ‘strategic purchasing’, which underlay the increased role of the private sectorin providing publicly funded services. It aims to contribute to the understanding on the way neoliberal reforms, which include those under SAPs and the UHC paradigm, have historically impacted country-level health systems and access of people to health care, and to bring out lessons from the resistance to these reforms

Methods

Findings

Discussion and conclusions