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

Abstract

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.

Medical Ethics arguments should be concordant with scientific knowledge and certain values

“… eşitsizlikleri artırdığı (15)(16)(17)(18)(19)  birinci basamak, koruyucu, toplum-merkezli hizmetlerden çok tedavi edici hizmetlere ağırlık verdiği (20)  sağlık sisteminin dezorganizasyonuna neden olduğu (21)  hekimlerin mesleki kimliklerini erozyona uğrattığı (22)  harcamaları gereksiz yere artırdığı (13,(23)(24)(25) saptanmıştır. Öyleyse, Tıp Etiği alanında kurulacak bir argümanın bilgisel öncüllerinin bu bilgilerden kaynaklanması, bu bilgilerle çelişmemesi o argümanın sağlamlığı açısından bir koşuldur.…”

Advancing health equity in the global marketplace: How human rights can help

“…More generally, market fundamentalism has proved inimical to health equity in multiple ways (Labonté, Schrecker, Packer, & Runnels, eds. 2009;Chapman, 2009) Monetary Fund to make health systems "sustainable" by way of cost recovery through user fees (Lister, 2005;Waitzkin, Jasso-Aguilar, & Iriart, 2007). It has also led to increases in poverty and economic inequality in some regions, resulting both from the growth of insecure and precarious employment and from a retreat from social protection (Labonté & Schrecker, 2007;Schrecker, 2009a).…”

Can Questions of the Privatization and Corporatization, and the Autonomy and Accountability of Public Hospitals, Ever be Resolved?

“…Deliberations on this issue have been stimulated by factors such as how to pay for health care, governments' perceived responsibilities for its provision, who should own and operate services, and how to induce greater levels of performance. There has been a worldwide dialogue about the appropriate role of governments in the health sector [48, p. 408, 8, 37, 45] and the extent to which the private sector should be involved [29,46,49]. At one end of the debate, some commentators say that governments should retain or regain primary responsibility for the health of all citizens, and hence the health system itself, in order to ensure there is equity through public provision [20,21,46,50].…”

“…There has been a worldwide dialogue about the appropriate role of governments in the health sector [48, p. 408, 8, 37, 45] and the extent to which the private sector should be involved [29,46,49]. At one end of the debate, some commentators say that governments should retain or regain primary responsibility for the health of all citizens, and hence the health system itself, in order to ensure there is equity through public provision [20,21,46,50]. At the other end, the government's main role is seen to be ensuring that the market for health services is working well, and whether provision is by public or private providers, or a combination of both, is irrelevant [28,35].…”

“…Proponents argue, essentially, that privatization and corporatization lead to several benefits including greater efficiency, better services and more choice [1,24,31]. Critics demur, and contend that privatization and corporatization engender mixed outcomes at best, and often induce confusion, poor responses and inequities which, as a result, compromise efficiency and quality of care [46,50,51].…”