Privatization Of Health Services Research Articles

The Visible Politics of the Privatization Debate in Quebec

This paper analyzes the debates surrounding the privatization of health services financing in Quebec. The objective is to clarify policy-making processes with regard to this important issue and, more generally, to provide a realistic understanding of health-related policy processes in Canada. The analysis is based on a large and continuous sample of mass media and National Assembly debates on the question during the four-and-a-half years following the Chaoulli ruling of the Supreme Court of Canada. These data are used to test four hypotheses about relationships among the types of political actors involved, their policy preferences, the rhetoric they use and the anticipated policy effects they assert. The results are applied to a discussion of questions about the factors that influence the effectiveness of political communication.

The effect of a poverty reduction policy and service quality standards on commune-level primary health care utilization in Thai Nguyen Province, Vietnam

Although universal access to quality health services is a primary policy goal of the Government of Vietnam (GOVN), economic restructuring and privatization of health services have been associated with emerging inequities in access to care. A GOVN programme for socio-economic development known as Program 135 (P135) designates communes known to be relatively poor as priority localities for development resources. Under this programme, basic curative and preventive health services, including some prescription drugs, are provided free of charge at commune health centres (CHCs). In an effort to improve the quality of care provided at CHCs, the national Ministry of Health (MOH) has implemented a set of national benchmarks for commune health care, which defines a minimum configuration of equipment, staff, training and other elements of service provision. This research examines the impact of P135 poverty reduction policy, achievement of MOH benchmark indicators and commune socio-economic characteristics on CHC utilization rates in Thai Nguyen Province, Vietnam. The analysis uses administrative data reported from 178 CHCs in Thai Nguyen Province for nine quarters, including 2004, 2005 and the first quarter of 2006. Mixed linear regression models are used to estimate the main and interaction effects on utilization rates of exposure to the P135 policies, achievement of MOH benchmarks, poverty, distance to the district hospital and ethnic composition. Communes that are poor and remote have comparatively high CHC utilization rates. Multivariate regression results suggest that communes exposed to the P135 policy have higher utilization rates, but these effects are conditional upon achievement of benchmark standards, thus perceived quality care enhances CHC utilization. Combining Program P135 with benchmark investment reduced the gap between primary health care utilization in poor communes versus those that are less poor. These commune-level findings suggest that CHC policies differentially benefit poor communities and reduce inequality in use of health care services.

Strengthening health care system in India: Is privatization the only answer?

Strengthening health care system in India: Is privatization the only answer?

Neoliberal Globalisation and Health: A Modern Tragedy

The neoliberal project for globalisation is characterised by two interlocking characteristics of economic liberalism imposed through an imperialist agenda. The global epidemic of HIV/AIDS can act as a model to show how neoliberal policies have been responsible for the unprecedented explosive spread of the disease, through its effect on income inequality, regional wars, women and the sex trade, mass migration, the ‘brain drain’ and the global drug trade. The implementation of neoliberal policies such as privatisation of health services and intellectual property rights by the World Bank, IMF and the WTO also severely inhibit our ability to control the biggest epidemic since the plague. The physical debilitation of large numbers of people in their productive and reproductive age inevitably effects the class struggle in many countries.

From Alma-Ata to the Global Fund: the history of international health policy

'Verticalization' of health care delivery, in one form or another, is the common theme pervading the history of international health policy over the last sixty years. It is often accompanied by radical policies of privatization of health services, everywhere resulting in people being forced to pay for all services. The failure of the vertical approach, of which the global public-private partnership initiatives are a modernized version, has been well recognized and its reasons are clear: actions on the distal determinants of disease (income, education, housing, the environment and infrastructure, etc) are overlooked; distribution of services dedicated to specific diseases and interventions (such as AIDS, malaria, tuberculosis, etc.) are artificially and temporarily reinforced, creating absurd and harmful forms of competition between services and making even more precarious and inefficient the work of already fragile basic health systems. This article describes the role played in this disturbing historical development by the prevailing economic ideology and its operational arm, the World Bank, with the view to reclaim international policy making processes and actors that really respond to people's health needs.

Costa Rica: Achievements of a Heterodox Health Policy

Costa Rica is a middle-income country with a strong governmental emphasis on human development. For more than half a century, its health policies have applied the principles of equity and solidarity to strengthen access to care through public services and universal social health insurance. Costa Rica's population measures of health service coverage, health service use, and health status are excellent, and in the Americas, life expectancy in Costa Rica is second only to that in Canada. Many of these outcomes can be linked to the performance of the public health care system. However, the current emphasis of international aid organizations on privatization of health services threatens the accomplishments and universality of the Costa Rican health care system.

Privatization of Health Services in Less Developed Countries: An Empirical Response to the Proposals of the World Bank and Wharton School

Academics and World Bank officials argue that, by reducing out-of-pocket expenditures, expanded private insurance may improve access to needed health services in less developed countries. In this empirical response, the authors examine this recommendation through observations from their research on privatization of health services in the United States, Argentina, Chile, and Mexico. Privatization, either through conversion of public sector to private sector insurance or by expansion of private insurance through enhanced participation by corporate entrepreneurs, generally has not succeeded in improving access to health services for vulnerable groups. Although the impact of privatization has differed among the Latin American countries studied, expansion of private insurance often has generated additional co-payments, which have increased rather than decreased out-of-pocket expenditures, thereby worsening access to needed services. Privatization usually has improved conditions for private corporations and has led to higher administrative costs. To address the devastating problems of access to services worldwide, we must find ways to enhance the delivery of public sector services and must move beyond conventional wisdom about market-based policies such as privatization.

The Hospital Employees' Union Strike and the Privatization of Medicare in British Columbia, Canada

AbstractIn April 2004, the Hospital Employees' Union (HEU) waged an illegal strike that mobilized sections of British Columbia's working class to the brink of a general sympathetic strike. Influenced by BC's class-polarized political culture and HEU's distinct history, the 2004 strike represents a key moment of working-class resistance to neoliberal privatization. HEU was targeted by the BC Liberal government because it represented a bastion of militant, independent unionism in a jurisdiction that appeared overripe (from the neoliberal standpoint) for a curtailment of worker rights and a retrenchment of public-sector employment. HEU also represented a direct barrier, in the language of its collective agreements and collective power of its membership, to the privatization of health services and dismantling of Medicare. The militant agency of HEU members, combined with anger generated by a constellation of social-service cutbacks, inspired rank-and-file workers and several unions to defy collective agreements and embrace sympathetic strike action. This revealed differentiation in the strategy and tactics of BC's labor leadership, and enduring sources of solidarity in labor's ranks.

Políticas del Sector Salud mexicano (1980-2004): ajuste estructural y pragmatismo de las propuestas neoliberales

In this paper we describe and analyze health policies impelled in Mexico during 1980-2004 (decentralization, health expenses reduction, selective primary health care, health services privatization) by neoliberal sectors. We describe the trajectory of these policies in a context characterized by poverty increase and socioeconomic inequalities. This analysis shows that these policies are characterized by their strong continuity, their adaptability, and in paticular their social, ideological and political pragmatism. The latter is evident in the use and appropriation by neoliberal functionaries and executives of concepts and proposals developed by medical and social critical approaches.

THE WORLD BANK: GLOBAL HEALTH OR GLOBAL HARM?

In recent years the World Bank has become “the world’s largest external funder of health.”1(p61) According to Ruger, this situation reflects the Bank’s increased sensitivity to poverty and its growing sophistication—beginning under the leadership of US Secretary of Defense turned World Bank President (1968–1981) Robert McNamara—about development theory and practice. Such an uncritical portrayal befits the World Bank’s own Web site (a major source for Ruger’s article), but Journal readers should expect more. Missing from this officialist version are discussions of the Bank’s undemocratic governance and decisionmaking structures; the untoward human effects of longstanding World Bank pro-privatization policies and practices, most notably structural adjustment programs (which have denuded the social welfare infrastructure of developing countries in areas such as housing, education, health services, subsidies, and family transfers); and the impact on health of the Bank’s newfound focus on the health sector. Ruger repeats the insider’s lament that lending policies were perennially subject to the exigencies of Wall Street bondholders, but she overlooks the far larger question of the nature and distribution of power at the World Bank. With votes directly related to shareholding size, World Bank decision-making is profoundly undemocratic, favoring elite interests within wealthy nations (the United States alone commands 16.4% of votes within the Bank). Any account of the Bank’s evolution ought to consider the impact of this governance structure on the roles and activities that the Bank adopts. According to both internal and external observers, the neoliberal policies advocated by the Bank and its sister institutions beginning in the 1980s have provoked or worsened dire economic conditions—and the attendant health effects, such as increased rates of malaria, HIV/AIDS, and tuberculosis—in much of the developing world.2–5 This “role of the World Bank in global health” remains unaddressed by Ruger. Indeed, the negative impact of structural adjustment programs on health conditions in developing countries helped spur the Bank’s focus on health in the late 1980s.6 With its double-entendre title, the Bank’s influential 1993 report Investing in Health hailed the importance of health to development while advocating the privatization of health services.7 But the Bank’s approach to health sector lending has exacerbated poor health outcomes by reducing access to health services for those unable to pay for care in newly privatized systems, which focus on cost recovery.8,9 Recent targeted programs aimed at the poorest ignore structural deficiencies in social services. In sum, Ruger portrays the Bank’s increasing involvement in the health sector as un-problematic. Critics are dismissed as a handful of cranks rather than as serious academic and policy researchers.10–12 The author’s reliance on official Web sites and published histories rather than internal memos, archives, and interviews, to which a former speech-writer for the World Bank president might have sought access, is disappointing. In failing to convert the price tags of projects into inflation-adjusted dollars—a surprising oversight for a health economist—Ruger underestimates the impact of past World Bank activities. Overall, this one-sided article fails to elucidate the powerful political and economic forces motivating World Bank policies and activities and does not provide the carefully researched historical analysis we have come to expect from “Public Health Then and Now” articles.

Mortality in China 1964–2000

This paper uses data from censuses and surveys to re-estimate mortality levels and trends in China ,from the 1960s to 2000. We use the General Growth Balance method to evaluate the completeness of death reporting above the youngest ages in three censuses of the People's Republic of China from 1982 to 2000, concluding that reporting quality is quite high, and revisit the completeness of death recording in the 1973–75 Cancer Epidemiology Survey. Estimates of child mortality from a variety of direct and indirect sources are reviewed, and best estimates arrived at. Our estimates show a spectacular improvement in life expectancy in China: from about 60 years in the period 1964–82 to nearly 70 years in the period 1990–2000, with a further improvement to over 71 years by 2000. We discuss why survival rates continue improving in China despite reduced government involvement in and increasing privatization of health services, with little insurance coverage.

Privatisation of Health Services and the Reproductive Health of Rural Chinese Women

China’s rural health care system has undergone major changes since the early 1980s, when the country began privatising rural health services. Following fiscal devolution, the rural primary health service was transformed into a fee-for-service system, dependent on the availability of local resources. This article reports some of the results of a study undertaken in 1994–96 to examine the impact of privatization on financing, provision and use of reproductive health services by women in two rural counties in Yunnan Province, China. The most common self-reported symptoms of reproductive morbidity were abnormal vaginal discharge and vaginal tears during home delivery, which went mostly untreated. Hospital-based delivery and use of antenatal care was very low, adversely affected by costs and perceived low quality. Service quality was affected by low investment in training, maintenance and supervision of workers. Most of the burden for maternal and child health care fell on local health workers, yet resources for these services had declined from 1985 to 1995. Only support for family planning services, which were funded and provided separately, had increased. Rural women’s reproductive health needs were inadequately attended to by rural health services following reforms. Our data has helped to increase attention to those needs within planned reform efforts.

Private Health Care in South Africa: Should the Unions Intervene?

The South African state's policy of privatization of health services has led to deterioration of public-sector health care and increased costs of access to this sector. This has generated an increasing demand for private health insurance among the predominantly black organized working class. These demands pose a dilemma for the progressive trade unions; negotiation of private-sector health insurance will have deleterious consequences for the equity and efficiency of the health services in general. Current trends in the private health sector also indicate that rapid cost increases will make most regular insurance packages unaffordable to the majority of workers within a few years. On the other hand, trade unions are obliged to meet the material demands of their members, and to intervene to stem the flow of individual workers to the private health sector. This article describes these trends, and the authors argue the case for intervention in this process by trade unions, in the form of union-negotiated and union-controlled "managed care" schemes. Such schemes will allow for the delivery of an adequate and appropriate package of health services at affordable rates. Union control will also allow for such structures to become the building blocks of a future national health service, and for incorporation into that service. Finally, the political implications of such interventions are addressed. The authors argue that the potential for undermining broader political campaigns and for creating divisions within the working class are important problems, but that many of these may be overcome through appropriate interventions.

Review: Health Services Privatization in Industrial Societies, London Papers in Regional Science 20. Growth and Change in a Core Region: The Case of South East England, Privatism and Urban Policy in Britain and the United States, Urban Innovation Volume 1. Urban Innovation and Autonomy: Political Implications of Policy Change, the Social Effects of Health Policy: Experiences of Health and Health

Review: Health Services Privatization in Industrial Societies, London Papers in Regional Science 20. Growth and Change in a Core Region: The Case of South East England, Privatism and Urban Policy in Britain and the United States, Urban Innovation Volume 1. Urban Innovation and Autonomy: Political Implications of Policy Change, the Social Effects of Health Policy: Experiences of Health and Health

Health Services Privatization in Industrial Societies.

Health Services Privatization in Industrial Societies.

Health services privatization in industrial societies

The theory and practice of health services privatization, Joseph L.Scarpaci. Part 1 Hospital services: growth of proprietary hospitals in the United States an historical perspective, James Bohl and Paul Leslie Knox privatizing the health and welfare state - the Western European experience, John Eyles restructuring the welfare state - the growth and impact of private hospitals in New Zealand, J.Ross Barnett and Pauline Barnett rolling back the state? - privatization of the health services under the Thatcher governments, John Mohan the politics of privatization - state and local politics and the restructuring of hospitals in New York City, Sara L.McLafferty. Part 2 The restructuring of mental health care in the United States, Christopher J.Smith deinstitutionalization and privatization - community-based residential care facilities in Ontario, Glenda Laws. Part 3 Environmental health services: privatization, federalism and cancer prevention in the United States - abdicating a noble goal, Michael R.Greenberg. Part 4 Developing countries - privatization in the periphery: dismantling public health services in authoritarian Chile, Joseph L.Scarpaci the role of multinational pharmaceutical firms in health care privatization in developing countries, Wilbert Gesler. Conclusions: lessons in the methodological and conceptual issues of health services privatization, Joseph L.Scarpaci.

Explaining trends in the privatization of health services in South Africa

Explaining trends in the privatization of health services in South Africa

Comments Received on Multinational Hospital Growth Trends in Privatization of Health Services

Comments Received on Multinational Hospital Growth Trends in Privatization of Health Services III. Multinational Operations of US For-Profit Hospital Chains Jane Sarasohn-Kahn CopyRight https://doi.org/10.2105/AJPH.78.5.592 Published Online: October 07, 2011

Comments Received on Multinational Hospital Growth Trends in Privatization of Health Services

Comments Received on Multinational Hospital Growth Trends in Privatization of Health Services

Comments Received on Multinational Hospital Growth Trends in Privatization of Health Services

Comments Received on Multinational Hospital Growth Trends in Privatization of Health Services