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Privatisation of Health Care in India2Globalisation and Health Services:An OverviewviewThe most significant and widespread global trend in healthcare over the past decade and more has been the increasingshare of the ‘for profit’ health care sector and itsmarketisation across societies. This transformation in thehealth care sector has paralleled the process of economicglobalisation and is intrinsically linked to it.While private medical practice and the dispensation ofmedical care for a price have been known for a long time,the commercialisation, marketisation and corporatisationof health care are a phenomenon of the last quarter of the20 th century. Due to global recession, this process receiveda boost during the late seventies and early eighties, envelopingboth developed and developing countries, imposingfiscal constraints on government budgets and encouragingthem to cut back on public expenditure in the socialsectors. This increased the space for the growth of theprivate sector in the provisioning of health care, whichwas accelerated during the eighties and nineties with theincreasing role of the pharmaceutical and medical equipmentindustries’ in seeking markets for their products.In this process of globalisation multinational corporationshave systematically targeted both international agencies andnational governments for policy influence, defining prioritiesfor disease control programmes, provisioning of healthcare and medical research at the national level. Typicallythese MNCs (multinational companies) have influencednational policies through multilateral agencies like the WorldBank, the World Health Organisation and the World TradeOrganisation, in key areas such as provisioning and researchin health care. They have influenced development fundingin the social sectors, securing focus for programmes witha higher curative content. They have encouraged the fundingof curative and drug-based programmes rather thanfocusing on public health and preventive programmes.Through the WTO, the policy framework for intellectualproperty protection has been aimed at protecting pharmaceuticalcompany bottom lines and helping them generatesuper profits. Such policy interventionism has ensuredthe funding of specific programmes, the creationof a market for drugs and equipment and the freeing ofstate control on the market. During the nineties, the WHOincreasingly went in for partnerships with the industry,especially for the tropical disease research programmes.(Brundtland, 2000)The increased influence of global drug multinationals inthe nineties has been facilitated by the recent trend towardsmergers and the increased concentration of sellingpower within the pharmaceutical industry. As a result ofthese mergers, a few corporations account for the bulkof pharmaceutical sales in the world. Many of these companiesexport drugs, vaccines and biological instrumentsto developed and developing countries. The majorpharmaceutical, equipment and insurance related MNCsare based in the United States. During the nineties they expandedtheir markets across several developing and developedcountries. This process was also accompanied by the2
Globalisation and Health Services: An Overviewincreased importance given to the growth of the ‘for-profit’health care sector.2.1. International Experience withMarketisation of Health CareThe trend towards the commercialisation and marketisationof health care during the last three decades cuts acrossboth developed and developing countries. While the UnitedStates has been a leader of the ‘market model’, the phenomenonis spreading even to “socialist” societies. Marketforces have largely controlled financing, provisioning andresearch in the health care sector in the U.S. Financing hasbeen largely managed through insurance companies, provisioningby large hospital corporations and research bypharmaceutical and medical equipment companies. Thegovernment’s role has been minimal and includes providingpublic insurance to the elderly and poor, drawing upregulatory guidelines for the private sector and giving subsidiesfor private medical care (Brown, 1984). Themarketised model of American medical care came undersevere criticism during the eighties. Criticism essentially focussedon the rising costs of medical care, excessive emphasison curative and high technology care, the dominanceof medical technology and pharmaceutical industriesin medical care. The critics further argued that thesetrends marginalised sections of the middle and workingclasses from access to health care. This was corroboratedby the increase in both the uninsured and under-insuredpersons during the eighties and the nineties. The uninsuredconsumers of health services were largely drawn from theworking class and some sections of the middle class.(Carrasquillo et al, 1999) Given the high cost of medicalcare, the uninsured were effectively denied access to healthcare. However, efforts to introduce universal public insuranceand other progressive reforms were resisted both bythe pharmaceutical companies and the ‘for profit’ healthcare providers.Despite the problems faced by the US health care system,most countries have been moving towards the Americanmodel of care where the private sector plays a dominantrole. This undoubtedly is a consequence of globalisationand the influence of the U.S. experience on other countries,an influence which has been partly communicatedthrough the media and public perceptions of what is acceptableand partly imposed by multilateral lending agencieslike the World Bank. These agencies have strongly advocatedprivatisation measures in health care as part of thestructural adjustment programmes. This position was wellarticulated in the World Development Report 1998, thatwas entitled, ‘Investing in Health’ (Rao, 1999).Countries in Europe, Africa, Latin America and Asia thathad built state-supported health services during the sixtiesand seventies, have now encouraged privatisation both asa response to the fiscal crisis of the public sector and tofulfil conditionalities linked to multilateral lendingprogrammes ( Jimenez & Bossert, 1995). The erstwhileSoviet Union and several central and eastern Europeancountries have gone through a process of marketisationwith a subsequent weakening, and in some cases even dismantling,of state services. Similarly, China has also beenmarketising its health services and is encouraging MNCsto enter the health care market. Studies show that increasingmarketisation of health care has pushed up the cost ofmedical care and has contributed to increased inequality inaccess to services across regions and classes in China(Acharya et al, 2001).Similar trends are visible in the UK, several West Europeancountries and in East Asia. In the UK, several Americanhospitals and insurance companies entered the market duringthe eighties. During the same period, efforts were madeto restructure the National Health Service in order to reducegovernment spending. Several other countries in Africaand Asia have followed similar paths, with reduction ingovernment spending on health care and an increased pushfor privatisation. This has meant the shifting of responsibilityto individual households to pay for health care (Price,1989). The consequences of marketisation have been welldocumented for Latin America and Africa, as also for someAsian countries. These studies show that access to care hasbeen reduced for the poor, costs of drugs are high, and theprivate sector serves only those who can pay.3
Page 3 and 4: Table of Contents123456Introduction
Page 5 and 6: Chhattisgarh Infrastructure ReportL
Page 7 and 8: Table of Contents123456Introduction
Page 9: Privatisation of Health Care in Ind
Page 13 and 14: 3Private Health Services in India:A
Page 15 and 16: Private Health Services in India: A
Page 17 and 18: Private Health Services in India: A
Page 19 and 20: 4Structure and Characteristics of P
Page 21 and 22: Structure and Characteristics of Pr
Page 23 and 24: Structure and Characteristics of Pr
Page 25 and 26: Utilisation of Private Health Servi
Page 35 and 36: 6ConclusionThis study has explored
Page 37 and 38: ReferencesAcharya, A.; Baru, R. and
Page 39 and 40: ReferencesShah, G. 1997. Public Hea

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