Global Health Watch 1 in one file

Health care systems | B1
for health care that is unnecessary or inappropriate; providing sub-optimal
(cheaper) health care in order to maximize net income; and providing inappropriate
care in order to market a supposed difference from other providers
(for example, advocating injections as better quality care when oral treatment
or simple health advice would be better).
Commercialization also affects the nature of health care itself. It encourages
a commodification of health care and a bias towards biomedical and
curative interventions because it is easier to market and sell tangible health
care products and services. Such commercialization benefits, and is therefore
encouraged by, the medical profession, pharmaceutical companies and the
Box B1.4 New Public Management
New Public Management (NPM) is a term used to describe private sector
solutions to public sector constraints. It is based on the idea that the monopoly
power of government, and the lack of competition to government
departments and civil servants that would otherwise compel them to be
efficient and accountable to service users, are responsible for bureaucratic
rigidity, corruption and inefficiency.
One NPM solution is to introduce competition between different public
sector departments and ‘internal markets’ (purchaser-provider splits)
within the public sector. Another is to restrict the role of government from
being a funder and supplier of services to that of a funder and contractor
of services. Public sector bureaucracy would then shrink as it moved
away from public management via bureaucratic control to ‘management
by contract’ of independent private sector providers, semi-independent
parastatal agencies or local government bodies. In some instances, public
sector entities are ‘corporatized’ (granted a greater degree of autonomy)
and expected to enter the provider market to compete for government
contracts and tenders.
The extent to which NPM has achieved its stated goals is contested
(Stewart 1998, Evans 1997, Maynard 1998, Khalegian and Das Gupta 2004).
Critics point to the high transaction costs associated with the management
of internal markets; the use of internal markets as a staging post towards
the eventual privatization of public services; the emphasis on competition
over collaboration; and the emergence of an inappropriately excessive ‘target-driven’
culture (see http://www.ghwatch.org/targetcultureNHS).
66