The Shift From State-Funded To Privatized Health-Tourism
Author: Arndt Saldsieder
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Keywords: Commercialization of Health Care, Neo-Liberalism, Health Tourism
Abstract
Health is a topic for all us. In todays society it happens more and more that the people are being made responsible for their health, when it used to be the task of the state to provide a functioning health-care system. This paper looks at the reason and implications for the health tourism of this development.
Beginnings
Most contemporary and on neo-liberal economic theory footing literature argues that the government should only fund the very basic curative needs of the people. In this approach individuals are considered to be “empowered” to act as consumers. This “efficiency” approach was made public by the World Bank within its Structural Adjustment Programs (SAP). This SAP had, inter alia, the goal to cut down public expenditure to make the sector more “efficient”. This program increased inequalities and made public health not just harder to access but weakened it overall. Additionally, it decreased quality, cost and provision of health care services. The actual negative effects of the SAP in developing countries are worse as its economic growth often conceals the negativity, at least to some extend (SMITH, 2012). It is not surprising to see little action taken by governments towards a more egalitarian approach since this rise of medial tourism reduces pressure on the governments as the beneficiaries are solely made up by the upper class – the ones with strongest voice (Connell, 2011). Within the new neo-liberal values of flexibility and mobility lay another reason the imbalance of private and public sector has not been tackled by state policies. While earlier it was the in the responsibility of the state to provide sufficient public health care for its citizens the change towards the privatized sector shifts this responsibility to the citizen (Ormond, 2011).
India - an Example
The rise of the privatized medical tourism could be considered as a result of neo-liberal policies as it caused steady investments into public medical sector to decline. This leads to a worsened access to health-care for the poor which can be displayed by the state of health-care for most Indian women. While India’s sector for assisted reproductive technology is booming and has women from all over the globe using it, only 17.3 percent of Indian women had ever contact with a health worker. This lack of professional assistance in India even when receiving child birth is also reflected in a maternal mortality of 0,3 percent. The combination of a steady increase in cost of hospitalization and the stagnation of public health expenditure since the 1990s causes indebtedness among the poor due to medical expenditures. With the dwindling funding of the public health sector it suffered immensely, which caused the people in need to look elsewhere and with the private sector as its only alternative that only lead to further legitimization (Sengupta, 2011).
Consequences
The privatization of the health sector not only places financial burdens on the poorer households but widens the gap between poor and rich even more socially. As expenditures often exclude some members of society from the needed care they are bound to stay poor and sick. This is even worsened as the poor health in turn causes lower income. This almost inescapable circle further enhances social segregation and health disparities (SMITH, 2012). Looking at mental health in particular the situation is especially difficult as traditional social works included advocacy, education and prevention – all not reimbursable under managed care. Social work services in a local environment often times tend more to the individual needs of the population. While also being the cheaper method social work shows responsibility to patients not subjecting them to problems caused by efficiency or cost-cutting (Rose and Keigher, 1996). The author would even argue that the privatization of the health sector provides another disservice to the mental health of the people. By shifting the responsibility of health-care in an unjust system people who suffer chronically from a physical disease go through an even greater ordeal because the system communicates it is the people’s fault for not living healthy enough or doing enough yoga. In this way are not just physical illnesses being left untreated but also new mental illnesses are bound to arise. New mental illnesses that the current health-care system is unfit to better in the wide population. An apt health-care system would provide for not just the privileged but for everyone. The great effect health tourism can have on disadvantaged families “non-travelers” has been shown by (McCabe, 2009).
Conclusion
Reflecting the whole paper most criticism of medical tourism can be seen as criticism of neo-liberalism, materialism and privatization. The importance of this paper shows when looking at the little number of papers having a discourse about the current health-care situation. This is even worsened by the fact that most of these papers only discuss health tourism from a pro neo-liberal perspective without even questioning the underlying system.
?
References
Hall, C. (2011). Health and medical tourism: a kill or cure for global public health?. Tourism Review, 66(1/2), pp.4-15.
Sengupta, A. (2011). Medical Tourism: Reverse Subsidy for the Elite. Signs: Journal of Women in Culture and Society, 36(2), pp.312-319.
SMITH, K. (2012). THE PROBLEMATIZATION OF MEDICAL TOURISM: A CRITIQUE OF NEOLIBERALISM. Developing World Bioethics, 12(1), pp.1-8.
Abstract
Health is a topic for all us. In todays society it happens more and more that the people are being made responsible for their health, when it used to be the task of the state to provide a functioning health-care system. This paper looks at the reason and implications for the health tourism of this development.
Beginnings
Most contemporary and on neo-liberal economic theory footing literature argues that the government should only fund the very basic curative needs of the people. In this approach individuals are considered to be “empowered” to act as consumers. This “efficiency” approach was made public by the World Bank within its Structural Adjustment Programs (SAP). This SAP had, inter alia, the goal to cut down public expenditure to make the sector more “efficient”. This program increased inequalities and made public health not just harder to access but weakened it overall. Additionally, it decreased quality, cost and provision of health care services. The actual negative effects of the SAP in developing countries are worse as its economic growth often conceals the negativity, at least to some extend (SMITH, 2012). It is not surprising to see little action taken by governments towards a more egalitarian approach since this rise of medial tourism reduces pressure on the governments as the beneficiaries are solely made up by the upper class – the ones with strongest voice (Connell, 2011). Within the new neo-liberal values of flexibility and mobility lay another reason the imbalance of private and public sector has not been tackled by state policies. While earlier it was the in the responsibility of the state to provide sufficient public health care for its citizens the change towards the privatized sector shifts this responsibility to the citizen (Ormond, 2011).
India - an Example
The rise of the privatized medical tourism could be considered as a result of neo-liberal policies as it caused steady investments into public medical sector to decline. This leads to a worsened access to health-care for the poor which can be displayed by the state of health-care for most Indian women. While India’s sector for assisted reproductive technology is booming and has women from all over the globe using it, only 17.3 percent of Indian women had ever contact with a health worker. This lack of professional assistance in India even when receiving child birth is also reflected in a maternal mortality of 0,3 percent. The combination of a steady increase in cost of hospitalization and the stagnation of public health expenditure since the 1990s causes indebtedness among the poor due to medical expenditures. With the dwindling funding of the public health sector it suffered immensely, which caused the people in need to look elsewhere and with the private sector as its only alternative that only lead to further legitimization (Sengupta, 2011).
Consequences
The privatization of the health sector not only places financial burdens on the poorer households but widens the gap between poor and rich even more socially. As expenditures often exclude some members of society from the needed care they are bound to stay poor and sick. This is even worsened as the poor health in turn causes lower income. This almost inescapable circle further enhances social segregation and health disparities (SMITH, 2012). Looking at mental health in particular the situation is especially difficult as traditional social works included advocacy, education and prevention – all not reimbursable under managed care. Social work services in a local environment often times tend more to the individual needs of the population. While also being the cheaper method social work shows responsibility to patients not subjecting them to problems caused by efficiency or cost-cutting (Rose and Keigher, 1996). The author would even argue that the privatization of the health sector provides another disservice to the mental health of the people. By shifting the responsibility of health-care in an unjust system people who suffer chronically from a physical disease go through an even greater ordeal because the system communicates it is the people’s fault for not living healthy enough or doing enough yoga. In this way are not just physical illnesses being left untreated but also new mental illnesses are bound to arise. New mental illnesses that the current health-care system is unfit to better in the wide population. An apt health-care system would provide for not just the privileged but for everyone. The great effect health tourism can have on disadvantaged families “non-travelers” has been shown by (McCabe, 2009).
Conclusion
Reflecting the whole paper most criticism of medical tourism can be seen as criticism of neo-liberalism, materialism and privatization. The importance of this paper shows when looking at the little number of papers having a discourse about the current health-care situation. This is even worsened by the fact that most of these papers only discuss health tourism from a pro neo-liberal perspective without even questioning the underlying system.
?
References
Hall, C. (2011). Health and medical tourism: a kill or cure for global public health?. Tourism Review, 66(1/2), pp.4-15.
Sengupta, A. (2011). Medical Tourism: Reverse Subsidy for the Elite. Signs: Journal of Women in Culture and Society, 36(2), pp.312-319.
SMITH, K. (2012). THE PROBLEMATIZATION OF MEDICAL TOURISM: A CRITIQUE OF NEOLIBERALISM. Developing World Bioethics, 12(1), pp.1-8.