Global Health Watch 1 in one file

the capacity of governments to regulate health care markets, encouraging cross
border ‘trade’ in health care, and facilitating the entry of corporate health businesses
to operate more freely within health care systems of other countries
(Hilary 2001, Shaffer et al. 2005).
The following sub-sections discuss three aspects of these effects on health
care systems: the growth in user fees; the segmentation of health care systems;
and the ‘commercialization’ of health care.
Box B1.2 Neoliberalism
The term ‘neoliberalism’ is used in different ways. Its origins may be in
economic theory, but it is used in this chapter to describe a particular orientation
to public policy. The US government under President Ronald Reagan
and the UK government under Prime Minister Margaret Thatcher were at
the heart of the emergence of neoliberalism in the 1980s. It was then propagated
globally by institutions such as the IMF and World Bank.
Neoliberalism is taken to mean the vigorous promotion of markets
– networks in which buyers and sellers interact to exchange goods and
services for money – combined with a reduction in government or multilateral
regulation. It was initially associated with promoting the maximum
freedom of movement for finance capital, goods and commercial services,
but now embraces the promotion of a minimally regulated market economy
in sectors that used to be considered the responsibility of the state.
These include sectors that provide essential services and public goods such
as health care, education, social security, water and sewerage, and policing
and prison services.
Concerns with neoliberalism relate to the weakening of governments’
ability to discharge their public duties such as reducing poverty; protecting
the public and environment from unregulated economic activity; and
providing a fair framework for the redistribution of wealth and profits.
user fees and the denial of access to essential health care One
effect of health sector reform was the promotion of a greater privatization of
health care financing (Box B1.3), including out-of-pocket payments for health
care in the public sector (Akin, Birdsall and Ferranti 1987), partly to offset reduced
levels of public expenditure. Such privatization added to the growth in
Approaches to health care
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