Neoliberal reforms in health systems and the construction of long-lasting inequalities in health care: A case study from Chile

Abstract

The aim of this article is to discuss how neoliberal policies implemented in the Chilean health system during the Pinochet regime have a lingering effect on equal access to health care today. The two-tier health system - public and private - that was introduced in the early 1980s as a means to improve efficiency and lower health-related costs, has led instead to inequality of access and dehumanisation of health care. Health has changed from being a right to being a marketable need, thus creating a structural disadvantage for several parts of the population - particularly the poor, the elderly, and women - who cannot afford the better-quality services and timely attention of private health providers, and thus, are not adequately protected against health risks. Despite the recent health reforms that aim at improving equity in health care access and financing, we argue that the Chilean health system is still biased against the poorer segments of the population, while it favours the more affluent groups that can afford private health care.

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“…Such notions and practices can have a detrimental effect on the health and access to health care services for groups that are already experiencing difficulties, such as children, the elderly, the poor, women, indigenous groups and people with disabilities. Evidence from Chile (Rotarou & Sakellariou, 2017a, 2017b, the first country where neoliberalism was adopted as the overall policy framework across all sectors, including health care, shows that neoliberal reforms have produced long-lasting, negative effects on health, disproportionately affecting the most vulnerable parts of the population.…”

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“…Even when the healthcare procedure is clearly definable (such as a hip operation) and has an easily measured outcome (such as survival), the creation of a parallel private sector to provide services reduces the number of staff available to work in the public sector and their training opportunities. Public health systems, such as those in Chile22 and Brazil,23 are chronically short of staff and getting progressively more limited in what they can provide as a result of a parallel private sector, a situation that is now emerging in the UK 24. High throughput NHS operating lists may offer advantages over outsourcing to the private sector—surgery would be delivered according to need, assessed using consistent criteria, provide supervised training opportunities, and carry negligible transaction costs.…”

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“…This results in the slashing of welfare spending of governments, increasing poverty and inequality. Liberalism stems from the work of Adam Smith's The Wealth of Nations , where he encourages minimal government intervention in the economy so that trade can flourish (Rotarou & Sakellariou, ). This liberal view of economy dominated for the following 150 years until it was replaced in the 1930s by Keynesian economics.…”

“…This economic model was the standard followed by high‐income nations from the later part of the Great Depression until the oil crisis in the 1970s. At this point, neoliberalism emerged in the economic and political debate with the introduction of neoliberal economic theories by Friedrich Hayek and Milton Friedman, and neoliberalism then spread after the elections of Margaret Thatcher in the United Kingdom and Ronald Regan in the United States (Bell & Green, ; Rotarou & Sakellariou, ).…”

“…In the current era of globalization, political power has changed its task to that of administering life as the machinery of production, and human beings, as the centerpiece of globalization, must adjust to the exigencies of the individualized, competitive, and consumerist market to survive (Bourdieu, ). In addition, economic development as a result of privatization of services has had serious effects on the quality, accountability, distribution, access, and equity of health and social systems around the world (Rotarou & Sakellariou, ). As such, the implementation of neoliberal regulations in the area of health and the deterioration of the welfare state has led us to forget that health is considered a human right (Vargas Bustamante & Mendez, ).…”