Trade unions, civil society organisations and health reforms.
Capital & Class › Nbr. 2009, June 2009
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Trade unions, civil society organisations and health reforms.
Public healthcare systems have become increasingly commodified in the past fifteen years, with the drivers for this commodification coming from several directions. National governments in high-income countries with aging populations are concerned about the increasing demand for healthcare services, particularly for high-technology treatments. Low taxation policies preclude the raising of more revenue for improved public healthcare services, and these have been reinforced by policies such as the European Union's Maastricht Treaty entry criteria, which set limits for public-sector spending.
National public healthcare systems have developed according to their own specific histories, and these often influence the effects of commodification and the nature of resistance to these changes. In low-income countries, the international financial institutions have imposed funding conditions that have forced government to introduce reforms of the public healthcare sector (Verheul & Rowson, 2001; Lister, 2006). Trade treaties have contributed to this process by encouraging policies of liberalisation, which have opened up public services to global multinational service companies (Lipson, 2002). The private sector has entered public healthcare systems through several mechanisms. As a way of preparing the public healthcare sector for competition and marketisation, one of the initial stages of reform is for public hospitals to become 'corporatised'--a process by which they have to operate according to business principles. This contributes to the commodification of healthcare, even if full privatisation does not take place (Sen, 2005; Leys, 2001). Services may be gradually contracted out to the private sector, often starting with catering, cleaning and facilities management before moving on to clinical services; and the development of public-private partnerships to build and manage new hospitals has presented many governments with an apparent solution to short-term funding, though in the long term, governments will be paying the private sector for inflexible long-term contracts (Pollock, 2004). Thus there is a growing presence of private-sector companies operating in public healthcare systems, as well as significant changes taking place in the role of government in public healthcare systems (Lethbridge, 2005). The impact of these changes on healthcare workers and on healthcare users has been felt in a variety of ways. For healthcare workers, their socioeconomic security has been undermined by either the introduction of corporatisation to public-sector hospitals, or the contracting out of services to the private sector. Changes in wage levels and terms and conditions are the immediate results of the commodification of public healthcare, leading to increasingly precarious employment (Afford, 2003). The lack of investment in public healthcare combined with deteriorating working conditions has resulted in depleted public health services (Laurell, 2001), and it has also led to the migration of skilled health workers from many low-income countries to higher-income countries. For healthcare users, the effect has often been to limit access and worsen the quality of the services delivered (Gilson, 1995; Bloom & Lucas, 1999; Bloom & Standing, 2001; Hilary, 2001). It also creates a feeling of insecurity about the future of healthcare provision. The introduction of user fees has often had a devastating effect, restricting access to healthcare even when there are exemptions for disadvantaged groups (Gilson, 1995; Nyonator & Kutsin, 1999; Jeppsson, 2001). The nature of healthcare...See the full content of this document
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