Multinational Corporations and Health Care in the United States and Latin America: Strategies, Actions and Effects

Abstract

In this article we analyze the corporate dominance of health care in the United States and the dynamics that have motivated the international expansion of multinational health care corporations, especially to Latin America. We identify the strategies, actions, and effects of multinational corporations in health care delivery and public health policies. Our methods have included systematic bibliographical research and in-depth interviews in the United States, Mexico, and Brazil. Influenced by public policy makers in the United States, such organizations as the World Bank, International Monetary Fund, and World Trade Organization have advocated policies that encourage reduction and privatization of health care and public health services previously provided in the public sector. Multinational managed care organizations have entered managed care markets in several Latin American countries at the same time as they were withdrawing from managed care activities in Medicaid and Medicare within the United States. Corporate strategies have culminated in a marked expansion of corporations' access to social security and related public sector funds for the support of privatized health services. International financial institutions and multinational corporations have influenced reforms that, while favorable to corporate interests, have worsened access to needed services and have strained the remaining public sector institutions. A theoretical approach to these problems emphasizes the falling rate of profit as an economic motivation of corporate actions, silent reform, and the subordination of polity to economy. Praxis to address these problems involves opposition to policies that enhance corporate interests while reducing public sector services, as well as alternative models that emphasize a strengthened public sector.The process of globalization raises several problems regarding health care and public health. Influenced by public policy makers in the United States, such organizations as the World Bank, International Monetary Fund (IMF), and World Trade Organization (WTO) have advocated policies that encourage reduction and privatization of health care and public health services previously provided in the public sector (Stocker et al. 1999;Iriart et al. 2001; Rao 1999;Turshen 1999; World Health Report 2000). These policies in turn have affected policies of the World Health Organization (WHO), the Pan American Health Organization, and the U. In addition to these non-commercial organizations, multinational corporations based in the United States have expanded worldwide. Managed care organizations, health care consulting firms, and pharmaceutical and medical equipment companies have entered foreign markets. U.S. industrial corporations also have operated in foreign countries; the participation of workers and the promotion of products in those countries have raised concerns about the impacts on local economies, environmental health, and occupational health (Kim et al. 2000). The "flight" of multinational corporations to f...

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