Deconstructing the Financialization of Healthcare

Hunter, Benjamin M.; Murray, Susan

doi:10.1111/dech.12517

Cited by 118 publications

(72 citation statements)

References 68 publications

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“…International health and development agencies pay lip service to other avenues for financing UHC, such as raising taxes or increasing aid flows [61], but in practice, the focus has been on establishing PPPs, supposedly to “expand access to higher-quality health services by leveraging capital, managerial capacity, and knowhow from the private sector” (p.vi) [62]. The underlying impetus for this direction of health-sector development comes from global finance capital [63, 64]. UHC has opened avenues for accumulation for private healthcare and health insurance industries [65, 66] as well as a myriad of global health consultancies vying for the clientele of national governments [67].…”

Section: Public Financing Of Private Healthcare: Contradictions and Pmentioning

confidence: 99%

Public–private partnerships for universal health coverage? The future of “free health” in Sri Lanka

Kumar

2019

Global Health

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Sri Lanka reports impressive health indicators compared to its peers in the South Asian region. Maternal and infant mortality are relatively low, and several intractable communicable diseases have been eliminated. The publicly financed and delivered “free” healthcare system has been critical to these health achievements. Placing the country’s healthcare system in historical context, this commentary analyses the contradictions and political tensions surrounding Sri Lanka’s 2018 Universal Health Coverage (UHC) policy, with attention to the Ministry of Health’s plans for public–private partnerships (PPP). As economic exigencies and private interests increasingly erode the 1951 “Free Health” policy, this commentary calls for a re-envisioning of UHC that can meet people’s aspirations for health and social justice.

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Section: Public Financing Of Private Healthcare: Contradictions and Pmentioning

confidence: 99%

Public–private partnerships for universal health coverage? The future of “free health” in Sri Lanka

Kumar

2019

Global Health

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“…Neoliberal austerity and retreat of the state from health systems have eroded publicly provided health systems and capacities (Labonté and Stuckler 2016 ; De Ceukelaire and Bodini 2020 ), with the counterpart marketization, privatization and commodification of healthcare expanding the private provision of health (Schrecker 2016 ). The ‘roll-out’ of health markets in LMICs (Sparke 2017 ; 2020 ) has also intensified (as it also has in high income countries), with the more recent rise of financialization of health service sectors since the 1990s, this process gathering pace markedly post-Global Financial Crisis with the entrance of hedge funds and investors into the hospital and allied health sectors (Hunter and Murray 2019 ). Private service provision now accounts for the majority of capacity the national health systems of many LMICs (Mackintosh et al 2016 ; McPake and Hanson 2016 ), with large multi-site providers catering more to wealthy patients and medical tourists (Chen and Flood 2013 ; Mossman et al 2019 ).…”

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confidence: 99%

COVID-19 and Private Health: Market and Governance Failure

Williams

2020

Development

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The COVID-19 pandemic has produced mass market failure in global private health, particularly in tertiary care. Low-and-middle income countries (LMICs) dependent on private providers as a consequence of neglect of national health systems or imposed conditionalities under neoliberal governance were particularly effected. When beds were most needed for the treatment of acute COVID-19 cases, private providers suffered a liquidity crisis, itself propelled by the primary effects of lockdowns, government regulations and patient deferrals, and the secondary economic impacts of the pandemic. This led to a private sector response—involving, variously, hospital closures, furloughing of staff, refusals of treatment, and attempts to profit by gouging patients. A crisis in state and government relations has multiplied across LMICs. Amid widespread national governance failures—either crisis bound or historic—with regards to poorly resourced public health services and burgeoning private health—governments have responded with increasing legal and financial interventions into national health markets. In contrast, multilateral governance has been path dependent with regard to ongoing commitments to privately provided health. Indeed, the global financial institutions appear to be using the COVID crisis as a means to recommit to the roll out of markets in global health, this involving the further scaling back of the state.

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“…It has been noted by other researchers from LMICs15 16 and high-income countries1 8 13 14 56 that the changing, and increasingly global, healthcare industry has significant implications for doctors and for their practice. In India, tensions are being felt by medical professionals with regard to opportunities and challenges in the contemporary healthcare system where growing public policy emphasis on private healthcare provision and on insurance modes of financing feeds into corporatisation processes.…”

Section: Resultsmentioning

confidence: 99%

“…Large multispecialty and superspecialty private hospitals offer a new model of care provision but beyond that, as we argue in detail elsewhere, corporate ways of working also impact on the management and operation of medium-scale hospitals and charitable trust hospitals within the private provision sector 7. In line with the global push to expand the healthcare industry supported by the World Bank’s International Finance Corporation and other development financing institutions, healthcare is being viewed as providing potentially lucrative business opportunities 8. However, a recent Lancet series highlighted how little is known about the operation of private providers and the difficulty in assessing their effects on healthcare 9 10…”

Section: Introductionmentioning

confidence: 99%

The impacts of corporatisation of healthcare on medical practice and professionals in Maharashtra, India

Marathe¹,

Hunter

Chakravarthi³

et al. 2020

BMJ Glob Health

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A heterogeneous private sector dominates healthcare provision in many middle-income countries. In India, the contemporary period has seen this sector undergo corporatisation processes characterised by emergence of large private hospitals and the takeover of medium-sized and charitable hospitals by corporate entities. Little is known about the operations of these private providers and the effects on healthcare professions as employment shifts from practitioner-owned small and medium hospitals to larger corporate settings. This article uses data from a mixed-methods study in two large cities in Maharashtra, India, to consider the implications of these contemporary changes for the medical profession. Data were collected from semistructured interviews with 43 respondents who have detailed knowledge of healthcare in Maharashtra and from a witness seminar on the topic of transformation in Maharashtra’s healthcare system. Transcripts from the interviews and witness seminar were analysed thematically through a combination of deductive and inductive approaches. Our findings point to a restructuring of medical practice in Maharashtra as training shifts towards private education and employment to those corporate hospitals. The latter is fuelled by substantial personal indebtedness, dwindling appeal of government employment, reduced opportunities to work in smaller private facilities and the perceived benefits of work in larger providers. We describe a ‘reprofessionalisation’ of medicine encompassing changes in employment relations, performance targets and constraints placed on professional autonomy within the private healthcare sector that is accompanied by trends in cost inflation, medical malpractice, and distrust in doctor-patient relationships. The accompanying ‘restratification’ within this part of the profession affords prestige and influence to ‘star doctors’ while eroding the status and opportunity for young and early career doctors. The research raises important questions about the role that government and medical professionals’ bodies can, and should, play in contemporary transformation of private healthcare and the implications of these trends for health systems more broadly.

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Deconstructing the Financialization of Healthcare

Cited by 118 publications

References 68 publications

Public–private partnerships for universal health coverage? The future of “free health” in Sri Lanka

Public–private partnerships for universal health coverage? The future of “free health” in Sri Lanka

COVID-19 and Private Health: Market and Governance Failure

The impacts of corporatisation of healthcare on medical practice and professionals in Maharashtra, India

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