Commercialization of Health Care: Global and Local Dynamics and Policy Responses (Social Policy in a Development Context)

## Preface and Acknowledgements This book is an outcome of UNRISD's innovative programme of research in Social Policy and Development, at the heart of which lies a commitment to demonstrate that inclusive social policy in low and middle income countries is and can be both economically developmental and democratically rooted. The aim of the programme is nothing less than to rebuild, through detailed primary research, the historical record, the political concepts, the economic frameworks and the understood case for democratic, inclusive and developmental institutions of social welfare in developing countries. In this intellectual and political task, health care is a key international battleground, on which competing visions of the ethical and political basis of society, and of the nature of the economy, are fought out. Health systems are powerful drivers of social exclusion or inclusion: key markers of a country's public ethics that play a central role in nation building and in response to national crisis. Internationally, the (patchy) international integration of health care markets and its consequences form a contested aspect of 'globalization', associated with intense political pressure on developing countries to adopt -intellectually and in policy terms -a market-led model of health care to which there is widespread local resistance. We analyse the extent to which, globally and locally, health care is becoming a commercialized sector of the economy, and explore the scope for creating good quality, inclusive health systems in that context. We very much hope that this book will contribute to a shift in the international 'common sense' in health policy, towards a more humane, inclusive, egalitarian and ethical framework for policy formulation. As co-ordinators and editors of the project, we would like to thank UNRISD, and specifically Thandika Mkandawire, for the intellectual and funding support that has made all this new primary research possible; also at UNRISD, Cynthia Hewitt de Alcàntara, Huck-Ju Kwon, Shahra Razavi, and Josephine GrinYates and Wendy Salvo; without the efficiency, hard work and warmth of Wendy and Jo, the project would simply never have happened. For support for the final project conference in Helsinki we also wish to thank Pertti Majanen, Matti Jaskari and Taisto Huimasalo from the Finnish Ministry for Foreign Affairs, and Kimmo Leppo from the Finnish Ministry for Social Welfare and Health; also Minna Ilva, Alexandre Peyre Dutrey, and Lorraine Telfer-Taivainen. Our thanks also to Avis Lexton for assembling and formatting the book manuscript. For further funding and material support we thank RUIG, the Réseau Universitaire International de Genève, STAKES in Finland and the Finnish Ministry for Foreign Affairs and also the Open University, UK. xiv ## Preface and Acknowledgements xv We also thank all our project participants and contributors, and also all those people to whom we have written over the two years of the project for help and advice, and who have responded so patiently and supportively. We learned a lot from participants and commentators in workshops in Geneva and at the Helsinki conference, including (from UN organizations) Ellen Health Care Is Increasingly A Market Sector, But The Process Of Commercialization Is Widely Contested. Rising International Trade In Health Services, Migration Of Health Care Personnel, Local Health Care Market Liberalization And Privatization, Cash Payment Within The Public Sector, Increasing Involvement Of Multinational Companies: All These Aspects Have Been Promoted By A Dominant Framework Of Thought In International Health Policy That Favours Commercialization Wherever Possible. Health Care Commercialization Poses Enormous Challenges For Health Planners And Activists Who Aim To Ensure Decent Health Care For All. This Book Is The First To Bring Together Economists And Health Policy And Public Health Experts From Across The World To Address The Issue Of Integrating These Different Aspects Of Health Care Commercialization. Based On Original Research, The Book Analyzes The Causes And Consequences Of Global And Local Commercialization In Health Care, And Argues For The Necessity And Possibility Of Effective Policy Responses To Develop Good Quality, Inclusive Health Systems Worldwide. The Book Aims To Contribute To A Shift In The International 'common Sense' In Health Policy Towards A More Humane, Inclusive, Egalitarian And Ethical Framework For Policy Formulation. Part 1: Commercialization: Nature, Causes And Effects -- Health Systems And Commercialization -- Health Systems And Commercialization: In Search Of Good Sense / M. Mackintosh And M. Koivusalo -- Globalization In Health Care: Strategies Of Multinational Corporations -- Strategies Of Multinational Health Care Companies In Europe And Asia / J. Lethbridge -- Multinational Companies And Health Care In The United States And Latin America: Strategies, Actions And Effects / R. Jasso-aguilar, H. Waitzkin And A. Landwehr -- Transnationalization And Commercialization In Middle Income Countries Health Care -- The Transnationalization Of The Health Care System In Argentina / C. Iriart -- The Dynamics Of Commercial Health Care In The Lebanon / K. Sen And A. Mehio-sibai -- The Interactions Between Social And Commercial Health Insurance After China's Entry Into The World Trade Organization / Q. Sun -- Commercialization And The Public And Community Health Sector --^ Commercialization In The Public Sector In India: Implications For Values And Aspirations / R.v. Baru -- On Shadow Commercialization Of Health Care In Russia / I. Blam And S. Kovalev -- Commercialization Of Health Care In Mali: Community Health Centres, Fees For Service And The Rise Of Private Providers / M.k. Konať And B. Kanť -- Part 2: Policy Issues And Responses -- Global Industrial Regulation And Its Health Implications -- Global Pharmaceutical Companies And Accessibility Of Drugs Under Trips / S. Chaudhuri -- International Collaboration On Medical Device Regulation: Issues, Problems And Stakeholders / C. Altenstetter -- Commercialization And Global Policies -- Restructuring Global Health Policy Making: The Role Of Global Public-private Partnerships / E. Ollila -- International Migration Of Health Care Staff: Extent And Policy Responses, With Illustrations From Ghana / K. Mensah -- Universalizing Health Care Access Under Commercialization --^ Eliminating Economic Barriers In Health Care: The Mexico City Government Experience / A.c. Laurell, E. Zepeda And L. Mussot -- The Political Economy Of National Health Insurance In Korea / H-j. Kwon And B. Tchoe -- Public/private Interactions And Health Equity Objectives -- The Search For Cross Subsidy In Segmented Health Systems: Can Private Wards In Public Hospitals Secure Equity Gains? / H. Wadee And L. Gilson -- Public Expenditure Allocation And Incidence Under Health Care Market Liberalisation: A Tanzanian Case Study / T.m. Kida And M. Mackintosh. Edited By Maureen Mackintosh And Meri Koivusalo. Includes Bibliographical References (pages 284-304) And Index. Cover......Page 1 Contents......Page 6 List of Figures and Tables......Page 9 Foreword......Page 13 Preface and Acknowledgements......Page 15 Notes on Contributors......Page 17 Part I Commercialization: Nature, Causes and Effects......Page 24 1 Health Systems and Commercialization: In Search of Good Sense......Page 26 2 Strategies of Multinational Health Care Companies in Europe and Asia......Page 45 3 Multinational Corporations and Health Care in the United States and Latin America: Strategies, Actions and Effects......Page 61 4 The Transnationalization of the Health Care System in Argentina......Page 74 5 The Dynamics of Commercial Health Care in the Lebanon......Page 89 6 The Interactions between Social and Commercial Health Insurance after China’s Entry into the World Trade Organization......Page 107 7 Commercialization and the Public Sector in India: Implications for Values and Aspirations......Page 124 8 On Shadow Commercialization of Health Care in Russia......Page 140 9 Commercialization of Health Care in Mali: Community Health Centres, Fees for Service and the Rise of Private Providers......Page 159 Part II Policy Issues and Responses......Page 176 10 Indian Pharmaceutical Companies and Accessibility of Drugs under TRIPS......Page 178 11 International Collaboration on Medical Device Regulation: Issues, Problems and Stakeholders......Page 193 12 Restructuring Global Health Policy-Making: the Role of Global Public–Private Partnerships......Page 210 13 International Migration of Health Care Staff: Extent and Policy Responses, with Illustrations from Ghana......Page 224 14 Eliminating Economic Barriers in Health Care: the Mexico City Government’s Experience......Page 239 15 The Political Economy of National Health Insurance in Korea......Page 257 16 The Search for Cross Subsidy in Segmented Health Systems: Can Private Wards in Public Hospitals Secure Equity Gains?......Page 274 17 Public Expenditure Allocation and Incidence under Health Care Market Liberalization: a Tanzanian Case Study......Page 290 References......Page 307 A......Page 328 C......Page 329 E......Page 331 G......Page 332 H......Page 333 I......Page 334 L......Page 335 M......Page 336 N......Page 338 O......Page 339 P......Page 340 R......Page 341 S......Page 342 T......Page 343 W......Page 344 Z......Page 345 "This book is the first to bring together economists and health policy and public health experts to create an integrated analysis of these different aspects of health care commercialization. Based on original research, the book analyzes the causes and consequences of global and local commercialization in health care, and argues for the necessity and possibility of effective policy responses to develop good quality, inclusive health systems worldwide. The book aims to contribute to a shift in the international 'common sense' in health policy towards a more humane, inclusive, egalitarian and ethical framework for policy formulation."--Jacket Based on original research and analysis by a group of health policy experts and economists from across the world, this book analyzes the causes and consequences of the expanding global and local commercialization of health care. It argues for the necessity and possibility of effective policy responses to develop good quality, universally inclusive health systems worldwide. The book aims to contribute to a shift in the international 'common sense' in health policy towards a more humane, inclusive, egalitarian, and ethical framework for policy formulation. "Transforming the Developmental Welfare State in East Asia explains the way in which shifts in economic strategy have influenced social policy reform in East Asia. This book also analyses the political dynamics of social policy in which economic imperatives for social reform were transformed into social policy reform. It tries to answer to what extent the particular politics of the country, either democratic or authoritarian, determined the course of social policy reform."--Jacket This book analyzes the expanding global and local commercialization of health care. It argues for the necessity and possibility of effective policy responses to develop good quality, universally inclusive health systems worldwide. The book aims to encourage a more humane, inclusive, egalitarian, and ethical framework for policy formulation. Economic development is a necessary but not sufficient condition for welfare development. Social security is limited in democracies with low levels of industrialization, even though some countries with a social democratic orientation seem to have done well. This work examines the relations between democracy and social policy